Title Page
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Site / Business name
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Conducted on
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Inspecting officer
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Inspection Report No.
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File No.
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Following this site inspection, an inspection report will be generated showing non-compliant items highlighted in red, while elements against UPSS industry best practice will appear in orange.
Site Details
Business & Contacts
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Site / Business name
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Site address
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Lot
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DP
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Person Responsible name
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Person Responsible phone
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Person Responsible email
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Site owner name
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Site owner phone
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Site owner email
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Nature of lease / responsibility for site & UPSS
- Major fuel company
- Supermarket associated
- Independent-major branded
- Independent-own branded
- Small independent
- Other
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Provide details
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Local Government Area
UPSS Operation
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Does an Exemption Order apply?
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Provide details:
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Total annual fuel sales (litres)
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Is the site located in a Vapour Recovery Region?<br>https://www.epa.nsw.gov.au/your-environment/air/reducing-motor-vehicle-emissions/vapour-recovery-service-stations
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Is there a Vapour Recovery System in place?
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VR1
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VR2
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VR1 = captures vapour from storage tanks when a tanker delivers petrol to the service station
VR2 = captures vapour at the bowser while a motorist refuels -
All UPSS operators inside the Vapour Recovery Regions must have a system installed.
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Tank information available?
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If a tank contains multiple compartments, record each compartment as a separate tank.
Tank
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Year tank was commissioned
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Construction material(s)
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Product contained
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Volume (litres)
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Operational status
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Provide details
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All UPSS operators are required to have this information available.
SECTION A: Fuel System Operation Plan (FSOP) or equivalent
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Does the site have an FSOP?
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Location
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The FSOP is required to be located onsite.
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Does the FSOP exist as separate documents?
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What format is the FSOP in?
- Electronic
- Hardcopy
Fuel System Operation Plan (FSOP) - Contents
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Does the FSOP contain business and contact details?
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The FSOP must have this element.
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Does the FSOP contain site security and access information?
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The FSOP must have this element.
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Does the FSOP have contact details for the Person Responsible for the UPSS?
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The FSOP must have this element.
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Does the FSOP indicate modification and monitoring records and their locations?
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The FSOP must have this element.
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Does the FSOP contain design standards / industry specifications?
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The FSOP must have this element.
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Does the FSOP contain details of the Loss Monitoring System?
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The FSOP must have this element.
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Are loss monitoring reports included in the FSOP?
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The FSOP must have this element.
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Does the FSOP contain an Incident Management Procedure?
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The FSOP must have this element.
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Does the FSOP contain details of the maintenance schedule?
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The FSOP must have this element.
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Does the FSOP contain plans / 'as-built' drawings of each UPSS?
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The FSOP must have this element.
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Does the FSOP contain details of employee induction and incident management training?
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The FSOP must have this element.
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All UPSS operators are required to have an FSOP.
SECTION B: Loss Monitoring System
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Is there a Loss Monitoring System in place?
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All UPSS operators must have a Loss Monitoring System in place.
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What type of Loss Monitoring System is it ?
- SIRA
- ATG
- Interstitial
- Manual dipping
- Other
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Provide details
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Are loss monitoring reports generated at least monthly?
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All UPSS operators are required to generate loss monitoring reports at least monthly.
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Is the Loss Monitoring System certified to detect a release of 0.76 L/hr of fuel?
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All Loss Monitoring Systems must meet this requirement.
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Does the Loss Monitoring System cover all tanks?
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The Loss Monitoring System must cover all installed tanks.
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Are discrepancies in litres delivered vs. litres sold investigated?
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All discrepancies must have evidence of further investigation as soon they are as identified.
SECTION C: Leak Detection System
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Is there a Leak Detection System in place?
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What type of Leak Detection System is it?
Groundwater wells
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Number of wells installed
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Is the installation report accessible onsite?
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The groundwater well installation report must be accessible.
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Is the testing procedure accessible onsite?
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The Leak Detection System testing procedure must be accessible.
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Are groundwater monitoring results accessible onsite?
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The groundwater well monitoring results must be accessible.
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Are the groundwater wells tested every 6 months?
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Groundwater wells must be tested every 6 months.
Alternative system
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Provide details
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Is the system designed by a duly qualified person?
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Alternative Leak Detection Systems must be designed by a duly qualified person.
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Is the testing procedure accessible onsite?
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The Leak Detection System testing procedure must be accessible.
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All UPPS operators must have a Leak Detection System in place.
SECTION D: Incident Management Procedure
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Is the Incident Management Procedure outlined in the Fuel System Operation Plan in place?
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All UPSS operators must have an Incident Management Procedure in place.
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Is an incidents log kept in the Fuel System Operation Plan?
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An incidents log must be kept in the Fuel System Operation Plan
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Are there steps in the Incident Management Procedure to mitigate spills / leaks?
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Incident Management Procedure must outline steps to mitigate spills and leaks.
SECTION E: Maintenance schedule
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Is there a schedule in place showing system maintenance? Such as fill points, sump pumps, gauges, sensors and other UPSS system and measuring instruments.
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Contains maintenance actions?
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This maintenance schedule must have this element.
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Contains frequency of maintenance?
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This maintenance schedule must have this element.
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Contains location of maintenance records
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This maintenance schedule must have this element.
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All UPSS operators are required to have a maintenance schedule in place.
Comments, areas for action / improvement
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Other environmental management issues
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This page contains industry best practices, but are not requirements. See Practice Note: Managing run-off from service station forecourts
https://www.epa.nsw.gov.au/-/media/epa/corporate-site/resources/contaminated-land/19p1681-practice-note-managing-run-off-from-service-station-forecourts.pdf?la=en&hash=9F0379C61DBE440562881E23D707BE7F3732DA70
SECTION F: Forecourt design operation and maintenance
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Are stormwater drains free of pollution?
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Are stormwater drains protected from spills?
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Is the forecourt area sealed and free from cracks?
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Does the forecourt area have a canopy with overhang?
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Is the forecourt area bunded for collecting surface runoff?
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Is there an oil / water separator? (or alternative)
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Is the oil / water separator appropriately maintained?
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Is there a trade waste agreement / permit?
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Is wastewater discharged to the sewer?
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Is wastewater treated prior to discharge?
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What alternative discharge option is used?
- Pump out of blind pit / sump
- Treatment then discharge to stormwater
- Other
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Provide details
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Is waste stored in a way to prevent a pollution incident?
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Are licensed waste contractors used, or are planned to be used to dispose of spill and leak waste?
SECTION G: Spill response and chemical storage
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Is a spill kit present, accessible, and adequately stocked?
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Is the spill kit regularly checked and refilled?
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Are sweep / vacuum / absorbent materials used to clean small spills and surface areas?
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Is there an up-to-date register of chemicals used and stored on the site?
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Are there relevant Material Safety Data Sheets on the site?
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Are employees aware of who to contact in the event of a spill?
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Are employees trained in spill clean up procedures?
Comments, areas for action / improvement
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