Walkthrough Inspection Form
Date of Inspection
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Inspector Name
First Name
Last Name
Tank Location
Facility PBS Registration Number
Tank Number
Year Tank Installed?
Is the tank inspection certificate posted?
Yes
No
Required Every 30 Days
Rows
Satisfactory
Repair or adjustment required
Not applicable
Visually check spill prevention equipment for damage.
1
2
3
Check for any obstructions
4
5
6
Check Fill cap to ensure securely fitted
7
8
9
For double-walled interstitial monitoring check for leakage.
10
11
12
Check release detection equipment has no alarm/unusual conditions.
13
14
15
Review current release detection records.
16
17
18
Required Annually
Rows
Satisfactory
Repair or adjustment required
Not applicable
Visually check containment sumps for damage or leaks.
19
20
21
Remove liquid/debris in contained sumps
22
23
24
Check for leaks in Double-walled containment sumps with interstitial
25
26
27
Check operability and serviceability of hand held release detection
28
29
30
General
Rows
Satisfactory
Repair or adjustment required
Not applicable
Inspect fill / monitoring ports ensure covers and caps sealed and locked.
31
32
33
Inspect for corrosion on UST
34
35
36
Insect for hoses, nozzles for loose fittings, deterioration.
37
38
39
Spill prevention equipment
Rows
Satisfactory
Repair or adjustment required
Not applicable
Spill prevention equipment is maintained at tank condition
40
41
42
Still prevention equipment is in good condition with adequate supplies
43
44
45
Tank pipelines
Rows
Satisfactory
Repair or adjustment required
Not applicable
Pipe services checked for signs of leakage
46
47
48
No signs of corrosion to pipelines or pipe supports
49
50
51
Buried pipelines are not exposed
52
53
54
Out of service pipelines are capped
55
56
57
Signs/barriers to protect aboveground pipes from vehicles are present
58
59
60
No leaks at valves, flanges, or other fittings
61
62
63
Secondary containment area
Rows
Satisfactory
Repair or adjustment required
Not applicable
Door to taint is in good condition
64
65
66
Door is locked
67
68
69
Available lighting system works properly
70
71
72
Overall Observations
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Service Quality
73
74
75
76
Cleanliness
77
78
79
80
Responsiveness
81
82
83
84
Inspector Signature
Submit
Submit
Should be Empty: