NMAC 20.5.50 Inspection Form

• Site

• Facility Sign

  Media
• Location
  Address

• API

• Location Type

  Select

• County

  Select

• State

  Select

• Inspection Type

  Select

• Frequency

  Select

• Conducted on

  Date

• Prepared by

• Were any leaks found associated with thief hatches, closed vent systems, pumps, compressors, pressure relief devices, open-ended valves or lines, valves, flanges, connectors, piping, and associated equipment?

  Yes

  No

  N/A
Leaks

• Equipment Type

  Select

• Leaking Component

  Select

• Leak Description

• Leak Picture

  Media

• Initial Repair Attempt Made?

  Yes

  No

  N/A

• Repair Successful?

  Yes

  No

  N/A

• Leak Repair Delayed?

  Yes

  No

  N/A

• What is reasoning leak repair was delayed?

  Yes

  No

  N/A

Pneumatic Controllers and Pumps

• Does the facility have gas-driven pneumatic pumps or controllers?

  Yes

  No

  N/A

• Has the Pneumatic Pump or Controller been inspected for leaks and proper working order?

  Yes

  No

  N/A

• Were any leaks on the controller or pump and associated piping and connections noted during inspection?

  Yes

  No

  N/A

• Were leaks repaired?

  Yes

  No

  N/A

• Will the leak be repaired within 30 days?

  Yes

  No

  N/A

• Is the pneumatic pump or controller operating normally?

  Yes

  No

  N/A

• Describe repairs made to controller or pump.

Storage Vessels

• Does this facility have any storage tanks subject to the requirements in 20.5.50.123

  Yes

  No

  N/A

• Was a AVO inspection of the storage tank performed?

  Yes

  No

  N/A

• Did the inspection find any evidence of leaks in the storage tank, hatch, or associated piping and gaskets?

  Yes

  No

  N/A

• Describe the leak found

• Was the leak able to be repaired?

  Yes

  No

  N/A

• Will the leak be repaired within 30 days?

  Yes

  No

  N/A

• Describe the reasoning for the delay in leak repair.

Control Devices

• Did the leak inspection include a flare, enclosed combustion device (ECD), thermal oxidizer (TO) or a vapor recovery unit (VRU)?

  Yes

  No

  N/A

• Were any leaks discovered during the inspection of this control system?

  Yes

  No

  N/A

• Signature

  Sign