SPCC Annual Inspection

• Conducted on

  Date

• Prepared by

• Retain record for at least 3 years after inspection date
  Inspection based upon STI SP001 Standard, 6th Edition (2018)

• Facility

  Select Albion Baxter Beaman Beaman Fast Stop Blairstown Fast Stop Brooklyn Buckeye Collins Fast Stop Garrison Fast Stop Garwin Gladbrook Grinnell La Porte City La Porte City East Bulk Plant Melbourne Millersburg Newton State Center Fast Stop Toledo Traer Traer Bulk Plant Van Horne Vinton Whitten

  • Albion
  • Baxter
  • Beaman
  • Beaman Fast Stop
  • Blairstown Fast Stop
  • Brooklyn
  • Buckeye
  • Collins Fast Stop
  • Garrison Fast Stop
  • Garwin
  • Gladbrook
  • Grinnell
  • La Porte City
  • La Porte City East Bulk Plant
  • Melbourne
  • Millersburg
  • Newton
  • State Center Fast Stop
  • Toledo
  • Traer
  • Traer Bulk Plant
  • Van Horne
  • Vinton
  • Whitten

Tank Foundation/Supports

• Free of tank settlement or foundation washout?

  Yes

  No

  N/A

• Concrete pad or ring wall free of cracking and spalling?

  Yes

  No

  N/A

• Tank supports in satisfactory condition?

  Yes

  No

  N/A

• Is water able to drain away from tank if tank is resting on a foundation or on the ground?

  Yes

  No

  N/A

• Is the grounding strap between the tank and foundation/supports in good condition?

  Yes

  No

  N/A

• Are there any comments or concerns about the tank foundation/supports?

Tank Shell, Heads, and Roof

• Free of visible signs of coating failure?

  Yes

  No

  N/A

• Free of noticeable distortions, buckling, denting, or bulging?

  Yes

  No

  N/A

• Free of standing water on roof?

  Yes

  No

  N/A

• Are all labels and tags intact and legible?

  Yes

  No

  N/A

• Are there any comments or concerns about the tank shell, heads, or roof?

Tank Manways, Piping, and Equipment

• Flanged connection bolts tight and fully engaged with no sign of wear or corrosion?

  Yes

  No

  N/A

• Are there any comments or concerns about the tank manways, piping, or equipment?

Tank Equipment

• Flanged connection bolts tight and fully engaged with no sign of wear or corrosion?

  Yes

  No

  N/A

• Normal and emergency vents free of obstructions?

  Yes

  No

  N/A

• Normal vent on tanks storing gasoline equipped with pressure/vacuum vent?

  Yes

  No

  N/A

• Are flame arrestors free of corrosion and are air passages free of blockage?

  Yes

  No

  N/A

• Is the emergency vent in good working condition and functional, as required by the manufacturer? Consult manufacturer's requirements. Verify that components are moving freely (including long-bolt manways).

  Yes

  No

  N/A

• Is interstitial leak detection equipment in good condition? Are windows on sight gauges clear? Are wire connections intact? If equipment has a test function, does it activate to confirm operation?

  Yes

  No

  N/A

• Are all valves free of leaks, corrosion, and other damage? Follow manufacturer's instructions for regular maintenance of these items. Check the following and verify (as applicable):<br><br>Anti-siphon valve<br>Check valve<br>Gate valve<br>Pressure regulator valve<br>Expansion relief valve<br>Solenoid valve<br>Fire valve<br>Shear valve

  Good

  Fair

  Poor

  N/A

• Are strainers and filters clean and in good condition?

  Good

  Fair

  Poor

  N/A

• Are there any comments or concerns about the tank equipment?

Tank/Piping Release Detection

• Free of missing insulation?<br>Insulation free of visible signs of damage?<br>Insulation adequately protected from water intrusion?

  Yes

  No

  N/A

• Is release detection being performed and documented if required?

  Yes

  No

  N/A

• Are there any comments or concerns about the tank/piping release detection?

Other Equipment

• Are electrical wiring and boxes in good condition?

  Yes

  No

  N/A

• Has the cathodic protection system on the tank been tested as required by the designing engineer?

  Yes

  No

  N/A

• Are there any comments or concerns about the other equipment?

Additional Comments and Inspector Signature

• Are there any general comments or concerns that should be noted on this annual inspection?

• Inspector Signature

  Sign