Title Page

  • Prepared by:

  • Payzone Employees/Contractors on Location

  • Customer:

  • Lease/Well Name:

  • Asset Number of Tank/Pit

  • Physical Location (Press the map pointer)
  • Inspection Date

  • Tank Barrel Capacity

  • Grounding rod and Cable drove into the ground

  • Is the Registration inside document tube ?

  • Is the conversion Conversion Chart attached and Legible?

  • FMCSA Annual Inspection- Is the sticker sticker displayed and current?

  • Sight Glass Present and Fluid Clearly Visble?

  • Valves Open and Close Freely

  • Payzone Logo Stickers in good condition and not peeling off ?

  • Handrails in good condition

  • Is the paint on tank satisfactory?

  • Wind Sock Present and in good condition?

  • All valve handles present?

  • Bolts on valves Tight

  • Are Bull Plugs in Place?

  • Thief Hatch Seals in good condition

  • Gas Buster Secured to the tank and in good condition

  • Pipe Inspection Bands visible and current

  • Ladder rungs in good condition

  • Fall Protection Static Line Available

  • Debris, Trash Sand etc in Tank?

  • Is there any damages or concerns with Tank not mentioned on the field above

  • 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.

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