UPSS Site Inspection Checklist

• Site / Business name

• Conducted on

  Date

• Inspecting officer

  Rachel Mann

  Alexander Habilay

  Jeremaia Marawa

• COM Number

• Inspection Type

  Routine

  Re-inspection

  Complaint

• 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.

Business & Contacts

• Site / Business name

• Site address
  Address

• Lot

• DP

• Person Responsible for UPSS name

• Person Responsible phone

• Person Responsible email

• Site owner name

• Site owner phone

• Site owner email

• Nature of lease / responsibility for site & UPSS

  Select Major fuel company Supermarket associated Independent-major branded Independent-own branded Small independent Other

  • Major fuel company
  • Supermarket associated
  • Independent-major branded
  • Independent-own branded
  • Small independent
  • Other

• Provide details

• Local Government Area

UPSS Operation

• Does an Exemption Order apply?

  Y

  N

• Provide details:

• Total annual fuel sales (litres)

• 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

  Y

  N

• Is there a Vapour Recovery System in place?

  Y

  N

• VR1

• VR2

• 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.

• Tank information available?

  Y

  N

• If a tank contains multiple compartments, record each compartment as a separate tank.

Tank

• Year tank was commissioned

• Construction material(s)

• Product contained

• Volume (litres)

• Operational status

  Operating

  Not currently used

  Decomissioned

  Other

• Provide details

• All UPSS operators are required to have this information available.

SECTION A: Fuel System Operation Plan (FSOP) or equivalent

• Does the site have an FSOP?

  Y

  N

• Location

  Onsite (accessible)

  Offsite

• The FSOP is required to be located onsite.

• Does the FSOP exist as separate documents?

  Y

  N

• What format is the FSOP in?

  Select Electronic Hardcopy

  • Electronic
  • Hardcopy

Fuel System Operation Plan (FSOP) - Contents

• Does the FSOP contain business and contact details?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain site security and access information?

  Y

  N

• The FSOP must have this element.

• Does the FSOP have contact details for the Person Responsible for the UPSS?

  Y

  N

• The FSOP must have this element.

• Does the FSOP indicate modification and monitoring records and their locations?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain design standards / industry specifications?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain details of the Loss Monitoring System?

  Y

  N

• The FSOP must have this element.

• Are loss monitoring reports included in the FSOP?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain an Incident Management Procedure?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain details of the maintenance schedule?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain plans / 'as-built' drawings of each UPSS?

  Y

  N

• The FSOP must have this element.

• Does the FSOP contain details of employee induction and incident management training?

  Y

  N

• The FSOP must have this element.

• All UPSS operators are required to have an FSOP.

SECTION B: Loss Monitoring System

• Is there a Loss Monitoring System in place?

  Y

  N

• All UPSS operators must have a Loss Monitoring System in place.

• What type of Loss Monitoring System is it ?

  Select SIRA ATG Interstitial Manual dipping Other

  • SIRA
  • ATG
  • Interstitial
  • Manual dipping
  • Other

• Provide details

• Are loss monitoring reports generated at least monthly?

  Y

  N

• All UPSS operators are required to generate loss monitoring reports at least monthly.

• Is the Loss Monitoring System certified to detect a release of 0.76 L/hr of fuel?

  Y

  N

• All Loss Monitoring Systems must meet this requirement.

• Does the Loss Monitoring System cover all tanks?

  Y

  N

• The Loss Monitoring System must cover all installed tanks.

• Are discrepancies in litres delivered vs. litres sold investigated?

  Y

  N

• All discrepancies must have evidence of further investigation as soon they are as identified.

SECTION C: Leak Detection System

• Is there a Leak Detection System in place?

  Y

  N

• What type of Leak Detection System is it?

  Groundwater wells

  Alternative system

Groundwater wells

• Number of wells installed

• Is the installation report accessible onsite?

  Y

  N

• The groundwater well installation report must be accessible.

• Is the testing procedure accessible onsite?

  Y

  N

• The Leak Detection System testing procedure must be accessible.

• Are groundwater monitoring results accessible onsite?

  Y

  N

• The groundwater well monitoring results must be accessible.

• Are the groundwater wells tested every 6 months?

  Y

  N

• Groundwater wells must be tested every 6 months.

Alternative system

• Provide details

• Is the system designed by a duly qualified person?

  Y

  N

• Alternative Leak Detection Systems must be designed by a duly qualified person.

• Is the testing procedure accessible onsite?

  Y

  N

• The Leak Detection System testing procedure must be accessible.

• All UPPS operators must have a Leak Detection System in place.

SECTION D: Incident Management Procedure

• Is the Incident Management Procedure outlined in the Fuel System Operation Plan in place?

  Y

  N

• All UPSS operators must have an Incident Management Procedure in place.

• Is an incidents log kept in the Fuel System Operation Plan?

  Y

  N

• An incidents log must be kept in the Fuel System Operation Plan

• Are there steps in the Incident Management Procedure to mitigate spills / leaks?

  Y

  N

• Incident Management Procedure must outline steps to mitigate spills and leaks.

SECTION E: Maintenance schedule

• Is there a schedule in place showing system maintenance? Such as fill points, sump pumps, gauges, sensors and other UPSS system and measuring instruments.

  Y

  N

• Contains maintenance actions?

  Y

  N

• This maintenance schedule must have this element.

• Contains frequency of maintenance?

  Y

  N

• This maintenance schedule must have this element.

• Contains location of maintenance records

  Y

  N

• This maintenance schedule must have this element.

• All UPSS operators are required to have a maintenance schedule in place.

Comments, areas for action / improvement

• 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

• Are stormwater drains free of pollution?

  Y

  N

• Are stormwater drains protected from spills?

  Y

  N

• Is the forecourt area sealed and free from cracks?

  Y

  N

• Does the forecourt area have a canopy with overhang?

  Y

  N

• Is the forecourt area bunded for collecting surface runoff?

  Y

  N

• Is there an oil / water separator? (or alternative)

  Y

  N

• Is the oil / water separator appropriately maintained?

  Y

  N

• Is there a trade waste agreement / permit?

  Y

  N

  N/A

• Is wastewater discharged to the sewer?

  Y

  N

• Is wastewater treated prior to discharge?

  Y

  N

• What alternative discharge option is used?

  Select Pump out of blind pit / sump Treatment then discharge to stormwater Other

  • Pump out of blind pit / sump
  • Treatment then discharge to stormwater
  • Other

• Provide details

• Is waste stored in a way to prevent a pollution incident?

  Y

  N

• Are licensed waste contractors used, or are planned to be used to dispose of spill and leak waste?

  Y

  N

SECTION G: Spill response and chemical storage

• Is a spill kit present, accessible, and adequately stocked?

  Y

  N

• Is the spill kit regularly checked and refilled?

  Y

  N

• Are sweep / vacuum / absorbent materials used to clean small spills and surface areas?

  Y

  N

• Is there an up-to-date register of chemicals used and stored on the site?

  Y

  N

• Are there relevant Material Safety Data Sheets on the site?

  Y

  N

• Are employees aware of who to contact in the event of a spill?

  Y

  N

• Are employees trained in spill clean up procedures?

  Y

  N

Comments, areas for action / improvement

• Inspection Result

  Pass

  Fail

• Action Required

  Select Warning Letter Re-inspection Prevention Notice Prohibition Notice Clean Up NOtice Penalty Notice

  • Warning Letter
  • Re-inspection
  • Prevention Notice
  • Prohibition Notice
  • Clean Up NOtice
  • Penalty Notice