• Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Fuel Company (UST)

  • Date & Time of Inspection

  • Tenant has a current Revocable Permit with AIR-PM for space.

  • Tenant has a current SPCCP on file with AIR-EE.

  • Quarter of Inspection

Above-ground Storage Tank (AST) Inspection

  • Fuel Dispensers Placarded, RE: AC 150/5230-4<br>

  • Fencing / Locks/ Signed, RE: AC 150/5230-4<br>

  • No Smoking warning properly posted in fuel farm area RE: NFPA 407:3-8 RE: AC 150/5230-4<br>

  • No Evidence of Smoking, RE: AC 150/523-4 <br>

  • No Ignition Sources Present, RE: AC 150/5230-4<br>

  • Fire Extinguishers: Proper size and type (Inspected), RE: NFPA 10 RE: NFPA 407 3-13*<br>

  • Fuel Farm Fueling Standard Operating Procedures, RE: FAR- AC 150/5230-4<br>

  • Fueling Procedures Observed, RE: AC 150/5230-4

  • Personnel Safety Training Requirements, RE: AC 150/5230-4<br>

  • Piping and critical areas free from leaks, RE: NFPA 407:2-4.6 RE: FAR- AC 150/5230-4<br>

  • Grounding connections & rods in good condition, RE: AC 150/5230-4<br>

  • Bonding Cable - Loading Station<br>

  • Fuel System Bonding & Grounded<br>

  • Fuel hose line, RE: NFPA 407:2-2<br>

  • Pressure test, RE: NFPA 407:3-16

  • Hose line condition, OK<br>

  • Emergency shut-off system, RE: NFPA 407:2-4.5<br>

  • Placarding of shut-off station proper, RE: NFPA 407:4-12.1<br>

  • Deadman Control - Loading Station, RE: AC 150/5230-4<br>

  • Housekeeping, RE: FAR- AC 150/5230-4<br>

  • Fueling area free of weeds, debris and other combustibles

Inspector's Photo(s) & Recommendations

  • Photo(s)

  • Recommendations

Signature(s), Date & Time of Inspection and Re - Inspection

  • Name & Signature of Inspector

  • Name & Signature of Operator

  • Date & Time

  • Date & Time of Re - Inspection

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