Title Page

  • Site

  • Facility Sign

  • Location
  • API

  • Location Type

  • County

  • State

  • Inspection Type

  • Frequency

  • Conducted on

  • 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?

  • Leaks
  • Equipment Type

  • Leaking Component

  • Leak Description

  • Leak Picture

  • Initial Repair Attempt Made?

  • Repair Successful?

  • Leak Repair Delayed?

  • What is reasoning leak repair was delayed?

Pneumatic Controllers and Pumps

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

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

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

  • Were leaks repaired?

  • Will the leak be repaired within 30 days?

  • Is the pneumatic pump or controller operating normally?

  • Describe repairs made to controller or pump.

Storage Vessels

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

  • Was a AVO inspection of the storage tank performed?

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

  • Describe the leak found

  • Was the leak able to be repaired?

  • Will the leak be repaired within 30 days?

  • 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)?

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

Inspector Verification

  • Signature

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