Airport Above-Ground Storage Tank (AST) Inspection Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Fuel Company (UST)

  Select Honolulu Community College Barbers Point Flight School DOT-A Kalaeloa Airport DOT-A Dillimgham Airfield Honolulu Soaring Club Skydive Hawaii Skydive Hawaii Mobile Tank

  • Honolulu Community College
  • Barbers Point Flight School
  • DOT-A Kalaeloa Airport
  • DOT-A Dillimgham Airfield
  • Honolulu Soaring Club
  • Skydive Hawaii
  • Skydive Hawaii Mobile Tank

• Date & Time of Inspection

  Date

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

  Yes

  No

  Pending Approval By AIR-PM

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

  Yes

  No

  Pending Approval By AIR-PM

• Quarter of Inspection

  First

  Second

  Third

  Fourth

Above-ground Storage Tank (AST) Inspection

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Bonding Cable - Loading Station<br>

  Yes

  No

  N/A

• Fuel System Bonding & Grounded<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Pressure test, RE: NFPA 407:3-16

  Yes

  No

  N/A

• Hose line condition, OK<br>

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Fueling area free of weeds, debris and other combustibles

  Yes

  No

  N/A

Inspector's Photo(s) & Recommendations

• Photo(s)

  Media

• Recommendations

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

• Name & Signature of Inspector

  Sign

• Name & Signature of Operator

  Sign

• Date & Time

  Date

• Date & Time of Re - Inspection

  Date