Title Page
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Prepared by:
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Payzone Employees/Contractors on Location
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Customer:
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Lease/Well Name:
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Asset Number of Tank/Pit
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Physical Location (Press the map pointer)
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Inspection Date
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Tank Barrel Capacity
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Grounding rod and Cable drove into the ground
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Is the Registration inside document tube ?
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Is the conversion Conversion Chart attached and Legible?
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FMCSA Annual Inspection- Is the sticker sticker displayed and current?
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Sight Glass Present and Fluid Clearly Visble?
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Valves Open and Close Freely
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Payzone Logo Stickers in good condition and not peeling off ?
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Handrails in good condition
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Is the paint on tank satisfactory?
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Wind Sock Present and in good condition?
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All valve handles present?
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Bolts on valves Tight
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Are Bull Plugs in Place?
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Thief Hatch Seals in good condition
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Gas Buster Secured to the tank and in good condition
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Pipe Inspection Bands visible and current
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Ladder rungs in good condition
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Fall Protection Static Line Available
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Debris, Trash Sand etc in Tank?
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Is there any damages or concerns with Tank not mentioned on the field above
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By signing, I agree I have completed this inspection to the best of my ability and have made every effort to notify management of the issues, if any.
