Cdot Form 540 – Fill Out and Use This PDF

COLORADO DEPARTMENT OF TRANSPORTATION						Location orgn				Location (required)
FUEL LOG						code #				Facility name:
										Street address
										City/Zip
Fuel usage
	Date	Orgn/	Veh #	Odometer	Quantity					Ending	Signature
	Yr__	Agency	(Funct)	or Hour clock	Unl(2)		Dsl(5)		meter reading
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Receipts  required  (attach copy of receipt to fuel log)

Date

Type fuel

Gauge or

Before sticking

After sticking

Quan recv'd

Vendor

Initials

(Unl/Dsl)

stick reading

IN'S

GAL'S

IN'S

GAL'S

From

From

invoice #

stick

ticket

Storage Tank Ullage

Total Tank Capacity_______

90% Tank Capacity______

Format conforms to requirements for Above ground Storage Tank Ullage Log from the Colo. Dept. of Labor &

Employment, Division of Oil & Public Safety

Date

Type Fuel

90 % Tank

Gauge or

Conversions to

(Ullage)

Quantity

Initials

(Unl/Dsl)

capacity

Stick reading

Gallons

Available

added

(Gallons)

capacity

Distribution: White - Accounting; Yellow - Storage Tank Site; Pink - Labor Employment Inspector	CDOT Form #540 10/12

ABOVEGROUND STORAGE TANK MONTHLY VISUAL INSPECTION FORM

Use either this form or its equivalent to document monthly visual inspections required by §3-5 of Colorado's Storage tank Reg-

ulations. Keep this record at least 12 months. However, it is advisable to keep records indeinitely, since they may be required as part of the compliance review concerning a claim for reimbursement from the Petroleum Storage Tank Fund.

1. Visible leaks on tanks, tank seams, connections, ittings or valves?	 no  yes, If yes, identify tank and describe leak.
Record action taken to remedy the problem and the date corrected.

2.Visible leaks on above-ground piping, pipe seams, connections, ittings, langes, threaded connections, pumps or valves?

 no  yes, If yes, identify and describe leak. Record action taken to remedy the problem and the date corrected.

3. Is overill prevention equipment in good operating condition?  no  yes  not applicable, If no, identify tank. Record action taken to remedy the problem and the date corrected. Verify operation of overill prevention equipment according to the equipment manufacturer's instructions. Verify operation of audible alarm if it can be tested.

4. If double-walled tank:

A. Is interstice free of liquid?  no  yes, If no, identify tank and describe leak. Record action taken to remedy the prob- lem and the date corrected.

B. Is interstitial monitoring equipment operating properly?  no  yes  not applicable, If no, identify tank. Record ac- tion taken to remedy the problem and the date corrected. Verify operation of interstitial monitoring equipment according to the equipment manufacturer's instructions.

5. Secondary containment system free of tank product or other liquids/debris, such as rainwater, snowmelt, dirt. leaves, trash, etc.?  no  yes  not applicable, If no, identify tank. Record action taken to remedy the problem and the date corrected.

6. Are concrete surfaces and ground free of any evidence of new leakage or spillage?  no	 yes, If no, describe. Record
action taken to remedy the problem and the date corrected.

Report suspected or conirmed leaks to the Division of Oil and Public Safety within 24 hours:

(303) 318-8547

Colorado Department of Labor and Employment, Division of Oil and Public Safety, 1515 Arapahoe Street, T3, #610, Denver, CO 80202

(303) 318-8505; http://oil.cdle.state.co.us