Statesville Feed Mill - SPCC Annual Facility Inspection Checklist

• Conducted on

  Date

• Prepared by

• Annual reminders:
  • Hold SPCC Briefing for all oil-handling personnel (and update briefing log in the Plan);
  • Check contact information for key employees and response/cleanup contractors and update
  them in the Plan as needed;

• This inspection record must be completed each year. If any response requires further elaboration, provide comments in Description & Comments space provided. Further description and comments, if necessary, must be provided on a separate sheet of paper and attached to this sheet. *Any item that receives “yes” as an answer must be described and addressed immediately.

Storage Tanks

Tank FO-1

• Tank surface shows signs of leakage

  Yes

  No

• Description & Comments

• Tank is damaged, rusted, deteriorated or corroded

  Yes

  No

• Description & Comments

• Bolts, rivets, or seams are damaged

  Yes

  No

• Description & Comments

• Tank support is deteriorated or buckled

  Yes

  No

• Description & Comments

• Tank foundation has eroded or settled

  Yes

  No

• Description & Comments

• Level gauge or alarm is inoperative

  Yes

  No

• Description & Comments

• Vent is obstructed

  Yes

  No

• Description & Comments

• Interstitial space contains no liquid

  Yes

  No

• Description & Comments

Tank FT-1

• Tank surface shows signs of leakage

  Yes

  No

• Description & Comments

• Tank is damaged, rusted, deteriorated or corroded

  Yes

  No

• Description & Comments

• Bolts, rivets, or seams are damaged

  Yes

  No

• Description & Comments

• Tank support is deteriorated or buckled

  Yes

  No

• Description & Comments

• Tank foundation has eroded or settled

  Yes

  No

• Description & Comments

• Level gauge or alarm is inoperative

  Yes

  No

• Description & Comments

• Vent is obstructed

  Yes

  No

• Description & Comments

• Secondary containment is damaged or stained

  Yes

  No

• Description & Comments

Piping

• Valve seals, gaskets, or other appurtenances are leaking

  Yes

  No

• Description & Comments

• Pipelines or supports are damaged or deteriorated

  Yes

  No

• Description & Comments

• Joints, valves and other appurtenances are leaking

  Yes

  No

• Description & Comments

• Fill and discharge piping is not properly connected

  Yes

  No

• Description & Comments

Loading/unloading and transfer equipment

• Connections are not capped or blank-flanged

  Yes

  No

• Description & Comments

• Secondary containment is damaged or stained

  Yes

  No

• Description & Comments

Security

• Fencing, gates, or lighting is non-functional

  Yes

  No

• Description & Comments

Response equipment

• Response equipment inventory is incomplete

  Yes

  No

  N/A

• Description & Comments

• Additional Remarks:

• Print Name and Sign

  Sign