Monthly UST Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Facility ID Number

Dispenser Area

• Dispenser Sumps

• Clean and Empty - No water, product debris

  Yes

  No

  N/A

• Sump Integrity - no leaks, cracks, bulges, holes

  Yes

  No

  N/A

• Leak Detection Sensor - Correct position and height

  Yes

  No

  N/A

• Piping Components

• No abnormal appearance of piping or components (rust, discoloration, delimitation, swelling)

  Yes

  No

  N/A

• Test boot (if applicable) pulled back so interstice is not blocked or obstructed

  Yes

  No

  N/A

• Product Shear Valve

• Properly secured and anchored. Installed at the proper level with no leaks.

  Yes

  No

  N/A

• Vapor Shear Valve (for Stage II Vapor Recovery Systems only)

• Properly secured and anchored

  Yes

  No

  N/A

• Installed at the proper level

  Yes

  No

  N/A

• Flex Connectors

• No leaks

  Yes

  No

  N/A

• Not in contact with soil (without catholic protection) or debris

  Yes

  No

  N/A

Leak Detection Equipment

• Automatic Tank Gauging System

• Leak test pass?

  Yes

  No

  N/A

• No Sensor alarms

  Yes

  No

  N/A

• Alarm history clear of alarms

  Yes

  No

  N/A

• Water alarm clear

  Yes

  No

  N/A

• Paper loaded (if applicable)

  Yes

  No

  N/A

• Interstitial Monitoring

• Manual Inspection if used for release detection.

  Yes

  No

  N/A

• Manual Inventory Control

• Inventory Reconciled

  Yes

  No

  N/A

• Automatic Line Leak Detection

• No leaks in the leak detector

  Yes

  No

  N/A

• Soil Vapor Monitoring

• Covers clearly marked and secured

  Yes

  No

  N/A

• Groundwater Monitoring

• Covers clearly marked and secured

  Yes

  No

  N/A

• Water present in wells

  Yes

  No

  N/A

• No product present in wells.

  Yes

  No

  N/A

Tank Area

• Tanks

• Inspect for water

  Yes

  No

  N/A

• Observation Wells

• Cover is tightly sealed, properly identified and secured

  Yes

  No

  N/A

• Cap is water tight and locked

  Yes

  No

  N/A

• Tank Venting Equipment

• Pressure/vacuum vent cap present (if required)

  Yes

  No

  N/A

• Spill Containment Manholes

• Cover is in good condition and properly identified

  Yes

  No

  N/A

• Clean, empty and dry - No water, product, dirt, debris

  Yes

  No

  N/A

• Sump integrity - No cracks, bulges, holes

  Yes

  No

  N/A

• No abnormal appearance of piping

  Yes

  No

  N/A

• Containment Sump Manholes

• Cover is in good condition and properly identified

  Yes

  No

  N/A

• Containment Sump

• Cover is in good condition and properly identified

  Yes

  No

  N/A

• Clean, empty and dry - No water, product, dirt, debris

  Yes

  No

  N/A

• Sump integrity - No cracks, bulges, holes

  Yes

  No

  N/A

• Sump Sensors

• Correct position and height, and operational

  Yes

  No

  N/A

• Flex Connectors

• No leaks

  Yes

  No

  N/A

• Not in contact with soil (without catholic protection) or debris

  Yes

  No

  N/A

• Stage I Vapor Recovery Manholes Two-Point (dual point)

• Cover is in good condition and properly identified

  Yes

  No

  N/A

• Sump (if present) integrity - No cracks, bulges, holes

  Yes

  No

  N/A

• Dry break poppet cap tightly sealed

  Yes

  No

  N/A

• Poppet seals tightly and moves freely when depressed.

  Yes

  No

  N/A

Corrosion Protection (if necessary)

• Impressed Current Cathodic Protection

• Rectifier is operating within normal limits

  Yes

  No

  N/A

Certification

• Signature

  Sign