Quarterly Inspection Report PDF Details

The Quarterly Inspection Report form plays a pivotal role in maintaining the integrity and safety of Underground Storage Tank (UST) systems. Designed to complement monthly release detection and testing protocols, this comprehensive document serves as a systematic checklist for facility operators to conduct thorough evaluations of their equipment and operations quarterly. It encompasses a wide spectrum of inspection items divided into multiple sections, including Tank Leak Detection, Tank Component Inspection, Piping Leak Detection Records, Piping Component Inspection, Corrosion Protection Records, and Corrosion Component Inspection. Additionally, it emphasizes the importance of spill protection, overfill prevention, dispenser and emergency shut-offs, and delineates the necessary emergency actions in the event of system alarms, spills, leaks, or releases. It provides a structured framework for ensuring that each component of the UST system functions correctly, from automatic tank gauges and interstitial sensors to corrosion protection systems and emergency shut-offs. Furthermore, the document underscores the significance of recordkeeping, requiring facility operators to verify that all inspection activities have been duly performed and to document any unusual conditions that might indicate potential problems or the need for corrective action. Integral to the form is the requirement for the active engagement of Class A/B operators in the inspection process, promoting accountability and adherence to established safety standards. The Quarterly Inspection Report form, with its detailed inspection criteria and procedural guidelines, is instrumental in facilitating the ongoing environmental compliance and operational safety of facilities with UST systems.

QuestionAnswer
Form NameQuarterly Inspection Report
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesquarterly vehicle inspection, state inspection facility in nj, motor vehicle inspection wait time, njmvc quarterly vehicle inspection report pdf

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OSFM Quarterly Equipment Inspection Checklist/Operations & Maintenance Guidelines

 

 

 

For UST System Inspections

 

Facility Name:

 

 

Facility ID:

 

THIS QUARTERLY INSPECTION IS IN ADDITION TO ALL OTHER MONTHLY RELEASE DETECTION AND TESTING REQUIREMENTS

 

 

 

 

 

 

 

 

 

UST Quarterly Inspection Equipment Items (place check mark in last column if unusual conditions (UC) exist)

 

 

 

 

 

 

CHECKED

N/A

UC

Section A.

 

Tank Leak Detection Records (Circle applicable number)

 

 

 

1.

Automatic Tank Gauge

Monthly passing print out tape

 

 

 

 

 

2.

Interstitial Sensors

Monthly status record of normal or equivalent - Annual functional test

 

 

 

 

 

 

Last tested:________

Test due:_________

 

 

 

3.

S.I.R. (Includes Warren Rogers)

Monthly status report normal or equivalent

 

 

 

4.

Manual Tank Gauging < 600 gal.

Weekly stick measurements with monthly reconciliation

 

 

 

5.

Vapor/Groundwater Monitoring

Monthly log with date, results and inspectors initials

 

 

 

6.

Water in Tank

Monitor ATG for water alarm or check tank utilizing gauge stick and water paste

 

 

 

Section B.

 

Tank Component Inspection

 

 

 

1.

Tank Monitoring System

Ensure system has power and is in a normal status with no alarms (daily)

 

 

 

2.

Submersible Sump Covers

Ensure all covers are present, in good condition and seated firmly

 

 

 

3.

Submersible Sump

Ensure no water is in submersible sump that contains interstitial sensors

 

 

 

 

 

If piping is single wall and corrosion prevention is installed, water is allowed

 

 

 

4.

Electrical

Ensure junction boxes are intact and no obvious wire breaks are visible

 

 

 

Section C.

 

Piping Leak Detection Records (Circle applicable number)

 

 

 

1.

Interstitial Sensors

Monthly status record of normal or equivalent - Annual functional test

 

 

 

 

 

 

Last tested:________

Test due:_________

 

 

 

2.

Mechanical Line Leak Detector

Annual precision test of lines and functionality test of leak detector

 

 

 

 

 

 

Last tested:________

Test due:_________

 

 

 

3.

Electronic Line Leak Detector

If proof of annual 0.1 gph system leak test is performed, a functionality test of

 

 

 

 

 

the leak detector is required only - If proof is not available a precision line test

 

 

 

 

 

will also have to be performed

Last tested:_______ Test due:_______

 

 

 

Section D.

 

Piping Component Inspection (Circle applicable number)

 

 

 

1.

Pressurized piping components

Ensure line leak detector is in place, if interstitial sensors are used, ensure they

 

 

 

 

 

are positioned at the lowest portion of the submersible and dispenser sump

 

 

 

2.

American Suction

Ensure monthly monitoring is in place

 

 

 

3.

Product Piping

Inspect for obvious leaks, deformations, cracks or other abnormalities

 

 

 

Section E.

 

Corrosion Protection Records (Circle applicable number)

 

 

 

1.

Impressed Current System

Monthly log with date, initials of inspector, hour, volt, amp and power on

 

 

 

 

 

verification - Annual system test: Last tested:_________ Test due:_________

 

 

 

2.

Sacrificial Anode System

System must be tested every 3 years: Last tested:________ Test due:________

 

 

 

3.

Internal Lining

Must be inspected every 5 years:

Last tested:_________ Test due:_________

 

 

 

Section F.

Corrosion Component Inspection (Circle applicable number)

 

 

 

1.

Impressed Current System

Ensure rectifier has power and power light functions, observe and record volt,

 

 

 

 

 

amp and hour meter readings

 

 

 

 

 

2.

Sacrificial Anodes

If anodes and connections are visible in submersible or dispenser sumps,

 

 

 

 

 

observe for obvious connection breaks of wiring from steel components

 

 

 

Section G.

 

 

Spill Protection

 

 

 

1.

Spill Protection Equipment

Ensure spill containment is in place, clean, dry & no obvious cracks/tears (daily)

 

 

 

Section H.

 

 

Overfill

 

 

 

1.

Automatic Shutoff

Ensure device is in place and free of restrictive items

 

 

 

2.

Overfill Alarm

Ensure device is in place and test function operates properly

 

 

 

Section I.

 

Dispensers and Emergency Shut-Offs

 

 

 

1.

Hose and Nozzle Components

Observe for obvious leaks, cracks & deformations. Ensure breakaway is installed

 

 

 

2.

Under dispenser

Ensure shear valve is in place and properly anchored. Observe for obvious leaks

 

 

 

 

 

Ensure interstitial sensors if installed are positioned at the lowest portion

 

 

 

 

 

Observe for obvious open electrical junction boxes or broken wiring

 

 

 

Section J.

 

Emergency Shut-Off

 

 

 

1.

Emergency Shut-Off

Ensure emergency shut-offs are accessible and have no obvious damage

 

 

 

 

 

 

Last tested:_________ Test due:_________

 

 

 

Section K.

 

Emergency Actions

 

 

 

1.

System Alarms

Ensure any alarms have been reported as required by facility operations plan

 

 

 

2.

Spills, Leaks or Release

Ensure any release has been reported as required by facility operations plan

 

 

 

Page 1

Remarks needed if unusual conditions exists (also incude the date owner was notified and actions taken):

Verify that each monthly recordkeeping requirement on the 1st page has been accomplished by initialing in the blanks below. (Initial

all that are applicable)

Tank Leak Detection/Interstitial Monitoring

Jan

Feb

March

April

May

 

June

July

 

Aug

 

Sept

Oct

Nov

Dec

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Line Interstitial Monitoring/Automatic Line Leak Detectors

 

 

 

 

Jan

Feb

March

April

May

 

June

July

 

Aug

 

Sept

Oct

Nov

Dec

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Impressed Current System

 

 

 

 

 

 

Jan

Feb

March

April

May

 

June

July

 

Aug

 

Sept

Oct

Nov

Dec

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Daily, Monthly, Quarterly, and Annual Inspection Items (indicate how often):

Daily:

Monthly:

Quarterly:

Annually: Submit annual Financial Responsibility Report from www.sfm.illinois.gov at Applications & Forms.

Identify the manner in which facility owners/operators will properly dispose of regulated substances spilled at the facility:

A/B Operators must conduct the quarterly inspections personally. Sign & date the form when inspection is done.

If using this form as part of your Operations & Maintenance Plan, attach the list of your class A/B & C Operators & your facility's Emergency Response Procedures form. The facility Owner must sign the O&M Plan with the A/B Operator, but only the A/B Operator is required to sign the Quarterly Inspection report.

Printed Name of A/B Operator

 

Signature of A/B Operator

 

Date of Inspection

(Quarterly Equipment Inspection Checklist -- Revised 12.15.14)

Page 2

 

 

 

 

 

 

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In the segment Electronic Line Leak Detector, Section D Pressurized piping, American Suction Product Piping, Sacrificial Anode System, Sacrificial Anodes, Section G Spill Protection, If proof of annual gph system, Piping Component Inspection Circle, Ensure line leak detector is in, Corrosion Protection Records, Corrosion Component Inspection, Ensure rectifier has power and, Spill Protection, Ensure spill containment is in, and Ensure device is in place and free enter the data which the system demands you to do.

stage 2 to completing nj mvc inspection stations

It is vital to record particular particulars inside the area Section J Emergency ShutOff, Section K System Alarms Spills, Observe for obvious leaks cracks, Emergency ShutOff, Ensure emergency shutoffs are, Last tested Test due, Emergency Actions, Ensure any alarms have been, and Page.

Entering details in nj mvc inspection stations stage 3

The Remarks needed if unusual, Verify that each monthly, Jan, Feb, March, Jan, Feb, March, Tank Leak DetectionInterstitial, May, July, April, Aug, Line Interstitial, and April area is the place to insert the rights and obligations of both parties.

stage 4 to finishing nj mvc inspection stations

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