AEG-Monthly UST Inspection

• Audit Title

• Client / Site

• Facility ID Number

• Location
  Address

• Conducted on

  Date

• Prepared by

  Select Nate Antieau Christine Caddick Andy Oleary George Ontko Brad Ziegler Nicholas Marcelletti Lauren Koloski

  • Nate Antieau
  • Christine Caddick
  • Andy Oleary
  • George Ontko
  • Brad Ziegler
  • Nicholas Marcelletti
  • Lauren Koloski

• Personnel

  Select Nate Antieau Christine Caddick Andy Oleary George Ontko Brad Ziegler Nicholas Marcelletti Lauren Koloski

  • Nate Antieau
  • Christine Caddick
  • Andy Oleary
  • George Ontko
  • Brad Ziegler
  • Nicholas Marcelletti
  • Lauren Koloski

Documentation

• Is Registration Certificate current and posted?

  Current/Posted

  Current/Not Posted

  Expired

• Expiration Date (as indicated in the body, NOT the upper corner).

  Date

• Financial Responsibility current?

  Current

  Expired

• Expiration Date

  Date

• ❕To add comments related to Documentation, check here.

• Comments regarding Documentation

• Add media

  Media

Testing

• ❗️If pressure system, check here.

• Is Line Leak Detector, Impact/Fire Valve, and Line Pressure testing current (required annually on pressure systems only)?

  Current

  Overdue

• Expiration Date

  Date

• Is Tank monitor, probe, sensor testing/certification current (required annually)?

  Current

  Overdue

• Expiration Date

  Date

• Is overfill protection device testing current (required triennially)?

  Current

  Overdue

• Expiration Date

  Date

• Is integrity testing of containment sumps (piping/spill) current (required triennially)?

  Current

  Overdue

• Expiration Date

  Date

• ❗️If system has Cathodic Protection,check here.

• Is Cathodic Protection testing current (required triennially)?

  Current

  Overdue

• Expiration Date

  Date

• ❕To add comments related to Testing, check here.

• Comments regarding Testing

• Add media

  Media

Dispenser Area

• ❗️If there are NO DISPENSERS as part of this system check here.

• ❗️If there are NO Dispenser SUMPS, check here.

• Internal Piping/Components

• Is any metal piping or braided metal flex in direct contact with soil or debris, without cathodic protection attached?

  No

  Yes

• No leaks from any piping, filters, or other components of the system?

  Yes

  No

• No abnormal appearance of cabinet, piping, or components (rust, discoloration, delamination, swelling, deterioration)?

  Yes

  No

• Product Impact/Fire Valve (required on pressure systems only): Properly secured and anchored, installed at proper level, with no leaks?

  Yes

  No

  N/A

• Dispenser Sumps

• Clean and empty: No water, product, or debris?

  Yes

  No

• Sump Integrity: No cracks,bulges, or holes?

  Yes

  No

• If double wall piping, is test boot pulled back or is interstice otherwise exposed to sump?

  Yes

  No

  N/A

• Internal Piping/Components

• ❗️If any dispenser does NOT have a sump, check here.

• Is any metal piping or braided metal flex in direct contact with soil or debris, without cathodic protection attached?

  No

  Yes

• No leaks from any piping, filters, or other components of the system?

  Yes

  No

• No abnormal appearance of cabinet, piping, or components (rust, discoloration, delamination, swelling, deterioration)?

  Yes

  No

• Product Impact/Fire Valve (required on pressure systems only): Properly secured and anchored, installed at proper level, with no leaks?

  Yes

  No

  N/A

• Cabinet and External Components

• Is cabinet securely mounted to grade?

  Yes

  No

• Splash guards, breakaway devices present?

  Yes

  No

• No damage to, or deterioration of hanging components (nozzles, swivels, breakaways, hoses, filters)?

  Yes

  No

• Are components current (nozzles, swivels, breakaways)?

  Yes

  No

• Signage present and legible (Warning, No Smoking, Fuel Identification)?

  Yes

  No

• Miscellaneous Items

• Is Emergency Shut-Off button present (within 20-100 ft.) and identified?

  Yes

  No

• Fire Extinguisher within 100 feet?

  Yes

  No

• Properly charged and inspected (annual inspection required)

  Yes

  No

• Area surfaces free of granular absorbent and/or untreated spills?

  Yes

  No

• No dispensers present as part of this system.

• ❕To add comments related to the Dispenser Area, check here.

• Dispenser Area Comments

• Add media

  Media

Leak Detection Methods/Equipment

• ➡️If non-ATG Automatic Interstitial Monitoring Device, or if Automatic Interstitial Monitoring is included in function of ATG, check Sensor Status monthly. Inspect piping sumps quarterly, or whenever sensors are not normal. If Manual Interstitial Monitoring is leak detection method, or if there are no sensors in piping sumps, piping sumps should be inspected monthly.

• Tank(s)

• Select method(s) of release detection

  Select ATG and/or Continuous Interstitial Monitoring Non-ATG Automatic Interstitial Monitoring Device Groundwater Monitoring Soil Vapor Monitoring

  • ATG and/or Continuous Interstitial Monitoring
  • Non-ATG Automatic Interstitial Monitoring Device
  • Groundwater Monitoring
  • Soil Vapor Monitoring

• ATG and/or Continuous Interstitial Monitoring

• No current sensor alarms

  Yes

  No

• Leak test pass (0.2 gph periodic)?

  Yes

  No

  N/A

• Inventory Control records present?

  Yes

  No

  N/A

• Leak test pass (CSLD/SCALD)?

  Yes

  No

  N/A

• Alarm history clear of alarms (past month)?

  Yes

  No

• Have alarms and responses been recorded?

  Yes

  No

• Are tank interstitial sensors normal?

  Yes

  No

  N/A

• Are piping sump sensors normal?

  Yes

  No

  N/A

• Paper loaded (if applicable)

  Yes

  No

• Leak test pass (CSLD/SCALD)?

  Yes

  No

  N/A

• Continuous Interstitial Monitoring is the method of release detection.

• Alarm history clear of alarms (past month)?

  Yes

  No

• Have alarms and responses been recorded?

  Yes

  No

• Are tank interstitial sensors normal?

  Yes

  No

  N/A

• Are piping sump sensors normal?

  Yes

  No

  N/A

• Paper loaded (if applicable)

  Yes

  No

• Alarm history clear of alarms (past month)?

  Yes

  No

• Have alarms and responses been recorded?

  Yes

  No

• Are tank interstitial sensors normal?

  Yes

  No

  N/A

• Are piping sump sensors normal?

  Yes

  No

  N/A

• Paper loaded (if applicable)

  Yes

  No

• Automatic Interstitial Monitoring Device (non ATG)

• Device operational, with no alarms on tank interstitial sensors, or piping sump sensors?

  Yes

  No

• Alarms and responses recorded?

  Yes

  No

• Groundwater Monitoring

• Cover(s) clearly marked and secured?

  Yes

  No

• Water present in well(s)?

  Yes

  No

• No product present in well(s)?

  Yes

  No

• Alarms and responses recorded?

  Yes

  No

• Soil Vapor Monitoring

• Cover(s) clearly marked and secured?

  Yes

  No

• Alarms and responses recorded?

  Yes

  No

• Piping

• Select method(s) of release detection.

  Select Automatic Line Leak Detection (Pressure Systems Only) Manual Interstitial Monitoring

  • Automatic Line Leak Detection (Pressure Systems Only)
  • Manual Interstitial Monitoring

• Automatic Line Leak Detection

• No leaks in the leak detector(s) (Slow flow, system shutdown)?

  Yes

  No

• Manual Interstitial Monitoring (See Piping Containment Sumps item in Tank Area Section below).

• ❕To add comments related to Leak Detection Methods/Equipment, check here.

• Leak Detection Methods/Equipment Comments

• Add media

  Media

Tank Area

• ❗️Check here if a gasoline tank is part of this system.

• Overfill Protection

• Select method(s) of Overfill Protection present. Overfill alarm is horn/strobe mounted somewhere in area of fuel fill. Automatic shut off device is mounted in fuel fill tube.

  Select Overfill Alarm Automatic Shut Off None Observed

  • Overfill Alarm
  • Automatic Shut Off
  • None Observed

• Overfill Alarm

• Are both audio and visual portions functional and within sight/hearing of fill port?

  Yes

  No

  Unable to Confirm

• Signage present (alerting bulk fuel delivery person to overfill devices in use)

  Yes

  No

• Automatic Shut Off Device

• Signage present (alerting bulk fuel delivery person to overfill devices in use)

  Yes

  No

• No Overfill Protection observed

• Spill Containment Sumps (Spill Buckets)

• Cover is in good condition and properly identified.

  Yes

  No

• Sump clean, empty, dry, and in good condition.

  Yes

  No

• Piping and components are in good condition, and cap seals tightly.

  Yes

  No

• Vapor Recovery/Venting Equipment (Vapor Recovery required on gasoline only)

• Coaxial

• Is coaxial vapor recovery device present on fuel fill pipe?

  Yes

  No

• ❗️Dual Point, Stage I Vapor Recovery ports (Check here if present).

• Dual Point, Stage I

• Cover in good condition and properly identified.

  Yes

  No

  N/A

• Sump (if present) is empty, dry, and in good condition.

  Yes

  No

  No sump

• Poppet cap is tightly sealed.

  Yes

  No

  N/A

• Poppet seals tightly and moves freely when depressed.

  Yes

  No

  N/A

• Dual Point, Stage I

• Cover in good condition and properly identified.

  Yes

  No

• Sump (if present) is empty, dry, and in good condition.

  Yes

  No

  No sump

• Poppet cap is tightly sealed.

  Yes

  No

• Poppet seals tightly and moves freely when depressed.

  Yes

  No

• Venting

• Pressure/Vacuum vent cap present?

  Yes

  No

  N/A

• Overfill Protection

• Select method(s) of Overfill Protection present. Overfill alarm is horn/strobe mounted somewhere in area of fuel fill. Automatic shut off device is mounted in fuel fill tube.

  Select Overfill Alarm Automatic Shut Off None Observed

  • Overfill Alarm
  • Automatic Shut Off
  • None Observed

• Overfill Alarm

• Are both audio and visual portions functional and within sight/hearing of fill port?

  Yes

  No

  Unable to Confirm

• Signage present (alerting bulk fuel delivery person to overfill devices in use)

  Yes

  No

• Automatic Shut Off Device

• Signage present (alerting bulk fuel delivery person to overfill devices in use)

  Yes

  No

• No Overfill Protection observed

• Spill Containment Sumps (Spill Buckets)

• Cover is in good condition and properly identified.

  Yes

  No

• Sump clean, empty, dry, and in good condition.

  Yes

  No

• Piping and components are in good condition, and cap seals tightly.

  Yes

  No

• ❗️If either Coaxial or Dual Point, Stage I Vapor Recovery is present, check here.

• Vapor Recovery/Venting Equipment (Vapor Recovery required on gasoline only)

• Coaxial

• Is coaxial vapor recovery device present on fuel fill pipe?

  Yes

  No

• ❗️Dual Point, Stage I Vapor Recovery ports (Check here if present).

• Dual Point, Stage I

• Cover in good condition and properly identified.

  Yes

  No

• Sump (if present) is empty, dry, and in good condition.

  Yes

  No

  No sump

• Poppet cap is tightly sealed.

  Yes

  No

• Poppet seals tightly and moves freely when depressed.

  Yes

  No

• Venting

• Pressure/Vacuum vent cap present?

  Yes

  No

• Vapor Recovery/Venting Equipment (Vapor Recovery required on gasoline only)

• No Vapor Recovery required on this system.

• Venting

• Vent riser present and in good condition?

  Yes

  No

• ❗️Piping Containment Sumps (Check here if present) If Automatic Interstitial Monitoring, inspect only quarterly, unless sensor(s) in alarm.

• Piping Containment Sumps

• Select configuration of system with piping sumps.

  Select Suction Pressure Gravity

  • Suction
  • Pressure
  • Gravity

• Cover is in good condition.

  Yes

  No

• Secondary cover is in good condition and seals to sump.

  Yes

  No

• Sump is clean, empty, dry, and in good condition.

  Yes

  No

• No damage or deterioration of components (conduit, piping, etc.)

  Yes

  No

• If double wall piping, and interstitial monitoring as leak detection, are test boots pulled back or is interstice otherwise exposed to sump?

  Yes

  No

  N/A

• Sump sensors present, at correct position/height, and operational.

  Yes

  No

  N/A

• If braided metal flex is present, there are no leaks and it is not in contact with soil or debris.

  Yes

  No

  N/A

• ❕To add comments related to the Tank Area, check here.

• Tank Area Comments

• Add media

  Media

Corrosion Protection (if required)

• ❗️If corrosion protection is required on this system, check here.

• ❗️If Sacrificial Anode system, check here.

• Sacrificial anode cathodic protection present on this system.

• ❗️Impressed Current Cathodic Protection (Check here if installed).

• Impressed Current Cathodic protection present on this system

• Rectifier is operating within normal limits.

  Yes

  No

• Rectifier readings recorded (required every 60 days)?

  Yes

  No

• No Corrosion Protection present or required on this system.

Miscellaneous Items

• Spill Materials: Comprehensive, appropriate, and sufficient materials present?

  Yes

  No

• ❕To add Comments, check here.

• Comments

• Add media

  Media

• ❕To add a sketch, check here.

• Sketches

Sketch

• Sketch

  Drawing

Certification

• Signature

  Sign