A21._Attachment_3_-_Monthly_Checklist.pdf

Rep-tank_checklist For Official Use Only

Page: 1

Date Printed:

Real Property ID:

Installation/GSU:

Unit/Organization:

Finding Status:

Assessor Duty Phone:

Conclusion:

Tank ID:

Installation Date:

Designation:

Location:

Model:

Checklist Name:MONTHLY ORGANIZATIONAL TANK ASSESSMENT

Perform Date:

Assessor:

Status:

Assessment Comments:

TANK CONTAINMENT

Are containment drain valves in working order and closed?

If the tank is a double wall tank was there water or fuel in the tank interstitial space?

Are there leaks, broken seals and/or corrosion of manhole covers?

Are there any indications of leakage, staining, or seepage around tank shell or concrete pad?

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Are there water accumulations, debris, vegetation, cracks, fire hazards or holes observed in the tank containment?

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Are there any indications of leakage, staining, seepage or severe corrosion on piping, pipe connections or pipe stands?

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TANK COMPLIANCE ASSESSMENT CHECKLIST

Contents:

Serial #:

Volume (gallons):

Page: 2

Date Printed:

Tank ID:

TANK CONTAINMENT

ADDITIONAL

Are there any indications of leakage, staining, seepage or severe corrosion on valves?

Are containment egress (exit) pathways clear?

Are gates/doors operable and in working order?

Are fire extinguishers maintained in a serviceable condition and located in the designated area?

Has an AF Form 332 been completed for any deficiencies observed?

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Are there any indications of leakage, staining, seepage or severe corrosion on tank supports/saddles?

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Is the tank level gauge working, readable and can be observed by the operator from the fill position location?

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Are ladders, platforms, handrails and stairs secure with no indication of severe corrosion and/or damage?

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TANK COMPLIANCE ASSESSMENT CHECKLIST

Real Property ID:

Page: 3

Date Printed:

Tank ID:

ADDITIONAL

Have all other Local, State, or Federal requirements checklist(s) been accomplished, if required, and documents uploaded to this tank record?

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Provide appropriate reference to record in comments.

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TANK COMPLIANCE ASSESSMENT CHECKLIST

Real Property ID: