SPCC/SWPPP Monthly Inspection Form

SPCC/SWPPP Monthly Inspection Form

Bingham and Taylor, 601 Nalle Place, Culpeper, VA 22701
Date:*

MonthDayYear
Date
Weather Conditions:
YesNo
1.0 ABOVEGROUND STORAGE

Aboveground Storage Tank inspections for oil/petroleum products are performed on a monthly basis using the Steel Tank Institute (STI) forms that are included in Appendix B of the SPCC/SWPPP Plan. Inspect for evidence of, or potential for, pollutants entering the stormwater drainage system. The consolidated findings should be identified here as acceptable ("OK") or as not acceptable ("Corrective Action Needed"). If corrective action is required, a Corrective Action Form should be completed.
OKCorrective Action Needed
2.0 SECONDARY CONTAINMENT STRUCTURES

Aboveground Storage Tank secondary containment inspections for oil/petroleum products are completed monthly using the Steel Tank Institute (STI) forms that are included in Appendix B of the SPCC/SWPPP Plan. The consolidated findings should be identified here as acceptable ("OK") or as not acceptable ("Corrective Action Needed"). If corrective action is required, a Corrective Action Form should be completed.
OKCorrective Action Needed
3.0 OFF-LOADING AREA & FUEL PUMP
OKCorrective Action Needed
OKCorrective Action Needed
4.0 PRODUCT/RAW MATERIAL STORAGE
OKCorrective Action Needed
OKCorrective Action Needed
5.0 TOTE & DRUM STORAGE
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
6.0 MISCELLANEOUS
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
7.0 SPILL RESPONSE EQUIPMENT
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
8.0 SECURITY
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
9.0 COMMUNICATION EQUIPMENT
OKCorrective Action Needed
10.0 FIRE PROTECTION RESPONSE
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
11.0 PRODUCT TRANSFER PIPING
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
12.0 DRAINAGE & STORMWATER
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
OKCorrective Action Needed
13.0 SPCC/SWPPP PLAN REVIEW
YesNoN/A
YesNoN/A
14.0 CORRECTIVE ACTION REVIEW
YesNo
YesNo
YesNo
YesNo
15.0 STEEL TANK INSTITUTE (STI) SP001 (EQUIVALENT) FORM - TANKS CHECKLIST

Enter Yes, No, or N/A in all open boxes. If response indicated as "No", a Corrective Action is required.

Tanks and Piping

Rows	AST-1	AST-2	AST-3
Is tank exterior (roof, shell, heads, bottom, connections, fittings, valves, etc.) free of visible leaks? Note: If "No", identify the tank and describe leaks and actions taken in comments below.
Is the tank liquid level gauge legible and in good working condition?
Is the area around the tank (concrete surfaces, ground, containment, etc.) free of visible signs of leakage?
Is the primary tank free of water or has another preventative measure been taken?
For double wall or double bottom tanks or CE-ASTs, is interstitial monitoring equipment (where applicable) in good working condition?
For double-wall tanks or double bottom tanks or CE-ASTs, is interstice free of liquid? Remove the liquid if it is found. If tank product is found, investigate possible leak.

Comments on Tanks and Piping

Equipment on Tank

Rows	AST-1	AST-2	AST-3
If overfill equipment has a "test" button, does it activate the audible horn or light to confirm operation?
Is overfill prevention equipment in good working condition?
Is the spill container (spill bucket) empty, free of visible leaks and in good working condition?
Are piping connections to the tank (valves, fittings, pumps, etc.) free of visible leaks? Note: If "No", identify location and describe leak in comments below.
Do the ladders/platforms/walkways appear to be secure with no sign of severe corrosion or damage?

Comments on Equipment on Tank

Containment (Diking/Impounding)

Rows	AST-1	AST-2	AST-3
Is the containment free of excess liquid, debris, cracks, corrosion, erosion, fire hazard, and other integrity issues?
Are dike drain valves closed and in good working condition?
Are containment egress pathways clear and any gates/doors inoperable?

Comments on Containment (Diking/Impounding)

Concrete Exterior AST (CE-AST)

Rows	AST-1	AST-2	AST-3
Inspect all sides for cracks in concrete. Are there any cracks in the concrete exterior larger than 1/16"?
Inspect concrete exterior body of the tank for cleanliness, need of coating, or rusting where applicable. Tank exterior in acceptable condition?
Visually inspect all tank top openings including nipples, manways, tank top overfill containers, and leak detection tubes. Is the sealant between all tank top openings and concrete intact and in good working condition?

Comments on Concrete Exterior AST (CE-AST)

Other Conditions

Rows	AST-1	AST-2	AST-3
Is the system free of any other conditions that need to be addressed for continued safe operation?

Comments on Other Conditions
Note: This form contains the elements required by STI SP001 for the Monthly Inspections. Triton has labeled this form as an equivalent form for STI SP001 as it fulfills the same requirements but is not identical to the form provided by STI.
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SPCC/SWPPP Monthly Inspection Form

1.0 ABOVEGROUND STORAGE

2.0 SECONDARY CONTAINMENT STRUCTURES

3.0 OFF-LOADING AREA & FUEL PUMP

4.0 PRODUCT/RAW MATERIAL STORAGE

5.0 TOTE & DRUM STORAGE

6.0 MISCELLANEOUS

7.0 SPILL RESPONSE EQUIPMENT

8.0 SECURITY

9.0 COMMUNICATION EQUIPMENT

10.0 FIRE PROTECTION RESPONSE

11.0 PRODUCT TRANSFER PIPING

12.0 DRAINAGE & STORMWATER

13.0 SPCC/SWPPP PLAN REVIEW

14.0 CORRECTIVE ACTION REVIEW

15.0 STEEL TANK INSTITUTE (STI) SP001 (EQUIVALENT) FORM - TANKS CHECKLIST