SPCC/SWP3 Monthly Inspection Form

• Site conducted

  Select

• Tilcon Connecticut Inc.- Plainville Facility

• Spill Prevention Control and Countermeasure (SPCC) Plan

• Stormwater Pollution Prevention Plan (SWP3)

• Tilcon personnel should conduct a detailed inspection of the entire facility once per month. the monthly inspections log identifies the principal ares, systems, and equipment that should be evaluated, at a minimum to meet the SPCC/SWP3 inspection requirements. A check should be placed (either "OK" or "Corrective Action Needed") next to each item evaluated. Where corrective action(s) is/are required, facility personnel should complete a Corrective Action Form. The inspector should sign and date this log immediately upon completion of the inspection.

• Employee Name:

  Sign

1.0 Above-Ground Storage

• OK

  Corrective Action Needed

• (Above-Ground Storage Tank inspections for oil/petroleum products are performed on a monthly basis using the Steel Tank Institute (STI) forms that are included in Appendix M of the SPCC/SWP3 Plan. The consolidated findings should be identified here as acceptable "OK" or as not acceptable "Corrective Action Needed". If corrective action is required, a Multi-media Corrective Action Form should be completed.

2.0 Secondary Containment Structures

• OK

  Corrective Action Needed

• (Above-Ground Storage Tank inspections for oil/petroleum products are performed on a monthly basis using the Steel Tank Institute (STI) forms that are included in Appendix M of the SPCC/SWP3 Plan. The consolidated findings should be identified here as acceptable "OK" or as not acceptable "Corrective Action Needed". If corrective action is required, a Multi-media Corrective Action Form should be completed.

3.0 Miscellaneous

• Housekeeping (trash,rags,etc.)

  OK

  Corrective Action Needed

• Miscellaneous chemical storage

  OK

  Corrective Action Needed

• Vegetation (fire hazard)

  OK

  Corrective Action Needed

4.0 Security

• Entrance/exit gates (operational, locks)

  OK

  Corrective Action Needed

• Lighting (operational)

  OK

  Corrective Action Needed

5.0 Communication Equipment

• Telephones

  OK

  Corrective Action Needed

• Handheld radios (operational, charged, location)

  OK

  Corrective Action Needed

6.0 Spill Response Equipment

• A. Sorbents (Pads, Spedi-Dry)

  OK

  Corrective Action Needed

• If corrected action is needed: select which categories apply:

  Select Inventory Storage Location Accessibility Operational Status Testing/Actual Use Shelf Life

  • Inventory
  • Storage Location
  • Accessibility
  • Operational Status
  • Testing/Actual Use
  • Shelf Life

• B. hand Tools (Maintenance Garage)

  OK

  Corrective Action Needed

• If corrected action is needed: select which categories apply:

  Select Inventory Storage Location Accessibility Operational Status Testing/Actual Use Shelf Life

  • Inventory
  • Storage Location
  • Accessibility
  • Operational Status
  • Testing/Actual Use
  • Shelf Life

• C. Communication Equipment

  OK

  Corrective Action Needed

• If corrected action is needed: select which categories apply:

  Select Inventory Storage Location Accessibility Operational Status Testing/Actual Use Shelf Life

  • Inventory
  • Storage Location
  • Accessibility
  • Operational Status
  • Testing/Actual Use
  • Shelf Life

• D. Fire Fighting and Personal Protective Equipment

  OK

  Corrective Action Needed

• If corrected action is needed: select which categories apply:

  Select Inventory Storage Location Accessibility Operational Status Testing/Actual Use Shelf Life

  • Inventory
  • Storage Location
  • Accessibility
  • Operational Status
  • Testing/Actual Use
  • Shelf Life

7.0 Fire Protection Response Equipment

• Water hydrants

  OK

  Corrective Action Needed

• Extinguishers

  OK

  Corrective Action Needed

8.0 Product Transfer Piping

• Signs of product leakage (droplets of product, discoloration, stains)

  OK

  Corrective Action Needed

• Condition (rust,corrosion)

  OK

  Corrective Action Needed

• Valves

  OK

  Corrective Action Needed

9.0 Drainage System

• Drainage Swale (to small on-site ponds)

  OK

  Corrective Action Needed

• On-Site Ponds

  OK

  Corrective Action Needed

T-24

1.0 Tank Containment

• 1.1 Containment Structure

  OK

  Corrective Action Needed

  Not Applicable

• 1.2 Primary Tank

  OK

  Corrective Action Needed

  Not Applicable

• 1.3 Containment Drain Valves

  OK

  Corrective Action Needed

  Not Applicable

• 1.4 Pathways and Entry

  OK

  Corrective Action Needed

  Not Applicable

2.0 Leak Detection

• 2.1 Tank

  OK

  Corrective Action Needed

  Not Applicable

• 2.2 Secondary Containment

  OK

  Corrective Action Needed

  Not Applicable

• 2.3 Surrounding Soil

  OK

  Corrective Action Needed

  Not Applicable

• 2.4 Interstice

  OK

  Corrective Action Needed

  Not Applicable

3.0 Tank Equipment

• 3.1 Valves

  OK

  Corrective Action Needed

  Not Applicable

• 3.2 Spill Containment Boxes

  OK

  Corrective Action Needed

  Not Applicable

• 3.3 Liquid Level Equipment

  OK

  Corrective Action Needed

  Not Applicable

• 3.4 Overfill Equipment

  OK

  Corrective Action Needed

  Not Applicable

4.0 Tank Attachments and Appurtenances

• 4.1 Ladders and Platforms

  OK

  Corrective Action Needed

  Not Applicable

5.0 Other Conditions

• if there are other conditions that should be addressed for continues safe operation or that may affect the SPCC plan explain in comments section.

• Comments: