HomeMy WebLinkAbout35810 013673 073 06-19-2021 MOWALK JDT MONTHLY WALKTHROUGH INSPECTION 55416.54 ADEM
30 DAY WALKTHROUGH INSPECTION
CHECKLIST LOG FOR YEAR ZOZ
FacilityName: P,(,tJ . , b, L, Owner: 1331 W ' / L xN
A , D f,CD, c.
Address: Owner:
Z y ' Terrell Wpate j A r.✓P-
Cit , Count , Zip: Cit , State, Zip:Sessp.-ier 4 L, 3 SDZO
Facility I.D. #: 132 7 9-O -O f o 7 3 Phone#: 7_0.5"- $/- Z O d
Inspector Name: 2oN�v e t,i9 i S or' Ins ector Phone#: os-- Zq_ D'777
Ins ector Compan �eNs 2
Instructions
1. Spill prevention equipment at UST systems receiving deliveries at intervals greater than every 30 days may only be checked prior
to each delivery.
2. Inspection must be performed in accordance with a nationally recognized code of practice(such as PEI RP-900,or equivalent),
manufacturer's instructions, or ADEM requirements.
3. Keep a copy of this inspection for 1 year. Questions on how to complete this form should be directed to the Groundwater Branch,
UST Compliance Section at(334)270-5655. L
��Montho!Inspection Jan Feb Mar Apr May Jun Jul I Aug Sep Oct Nov Dec
I Day of inspection
Spill Containment Equipment(Spill Bucket)Visual Inspection
Evidence of a release
from spill bucket? ❑ yes ❑yes ❑yes ❑yes ❑yes El ye ❑yes ❑yes ❑yes e� ❑yeses
(If release found, ❑ ❑
report it to ADEM) ❑ no no no ❑ no ❑ no io ❑ no ❑ no Ono ❑ no no
Spill bucket free of ❑yes ❑yes ❑yes ❑yes ❑yes O.y'es ❑yes ❑yes ❑damage? ❑ no ❑ no ❑ no ❑ no ❑no ❑ no ❑ no ❑ no y ❑es yes �❑ye yes
no El no
Spill bucket free of no no
water, fuel, and/or ❑Yes ❑yes ❑yes ❑yes ❑yes yes ❑yes ❑yes ❑)yes ❑ y s es ❑yes
debris? ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ nd" no ❑ n no ❑ na��
yes ❑
Was water,fuel and/or ❑yes ❑yes ❑yes ❑yes ❑yes ❑ yes yes ❑y ❑ ye ❑yes ❑feis
debris disposed of ❑no ❑ no ❑ no ❑ no ❑ no ❑ no, ❑ no no. ❑no ❑ no ❑ no 0
properly? ❑n/a ❑ n/a ❑n/a ❑ n/a ❑n/a gA,(1a ❑ n n ❑ n/ ❑ n/a ❑ n/a /a
Is the fill pipe free of ❑yes ❑ yes ❑yes ❑yes ❑ yes [des ❑yes yes ❑ es ❑yes ❑ye$/ yes obstructions? ❑no ❑ no ❑no ❑ no ❑ no ❑ no ❑no no ❑ o ❑ no ❑ o(( ❑ no
Does the fill cap fit ❑yes ❑ yes ❑yes ❑yes ❑yes Byes ❑yes yes ❑ ❑ yes ❑ ❑yes
securely on fill pipe? ❑no ❑ no ❑ no ❑ no ❑ no ❑nfl ❑ no no ❑ n ❑ no ❑ ❑ no
If double walled spill ❑yes ❑ yes ❑yes ❑yes ❑yes es ❑yes yes ❑yes ❑ e bucket, is interstitial no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no no no ❑yes ❑ye s
space free of liquid? ❑ n/a ❑ n/a ❑ n/a ❑ n/a ❑ n/a ❑ ra no ❑ no a1-1 n n ❑ n Results of spill ❑pass ❑pass ❑pass ❑pass ❑pass pass ass❑ ass ❑pass ❑pass ❑pass []pass
bucket inspection ❑fail ❑fail ❑fail ❑fail ❑fail Qfail ❑fail ❑ it ❑fait/ ❑fail ❑fail ❑fail
Inspector's initials
Release Detection Equipment Inspection
Release detection �
operating with no ❑yes ❑ yes ❑yes ❑yes ❑yes 0 yes ❑yes ❑yes ❑yes ❑ yes ❑yes ❑yes
alarms or unusual ❑ no ❑ no ❑ no ❑no ❑no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no
—operating conditions?
Release detection El yes ❑ yes ❑yes ❑yes ❑ yes testing records are yes ❑yes ❑ yes ❑yes ❑ yes ❑yes ❑yes
passing and current? ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no ❑ no
Results of RD ❑pass ❑pass ❑pass ❑pass ❑pass Q ass ❑pass ❑pass ❑pass ❑pass ❑pass ❑pass
equipment inspection ❑fail ❑fail ❑fail ❑fail ❑fail ❑fail 7 fail ❑fail ❑fail ❑fail ❑fail ❑fail
Inspector's initials
Repairs Needed Date of Repair Description of any Repairs
I
i
ADEM Form 558 3/18 m2(revised 8/19)
a