Maintenance Request

Maintenance / Inspection Report
Customer
Contact Name
First NameLast Name
Contract/ Tank No
E-mail
Phone Number
Area CodePhone Number
Date
MonthDayYear
Date
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
LWE Tank Plate Available?
Tank Serial No / Plate photo
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Tank Description
Date of Manufacture and capacity
overall dims
internal dims

Rows	yes	no
Protected from Damage
Protected from un-authorised use
Fitted with Non-return valve

On site Diesel Bug Test, sample taken for analysis. Results will take a couple of weeks
20 Litre fuel test Result
Rows Pass border line Fail
Result
Insert photo of Test result
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Date
MonthDayYear
Date
Spillages / Leaks and comments
Insert picture of any leaks
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Insert picture of any leaks
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Rows	Pass	border line	Fail
Result

Rows	Yes	No
Tank fill notice displayed
Label present showing capacity
Label present showing product type
Is vent pipe visible when filling
has tank got screw or other fixed coupling
is the coupling in good condition
Is an overfill device fitted
Is a lockable cap and chain in use
Is a spill kit available
Is the drip tray being used

Rows	Yes	No	Need work carried out
Is the pipework secure?
Is a non Return Valve Fitted?
Mechanical Joints accessible for inspection?
Adequate Leak Detection fitted?
Extended pipes fitted with Shut off Valves?
Are Filters in Pipework?
Above Ground pipes sufficiently supported?
Above ground pipes protected from physical damage?
Above ground pipes, Any loads on pipework ?
Above ground pipes Protected from Corrosion?
Underground pipes Are the routes Known?
Underground pipes, are routes marked out on a plan?
Underground pipes, the inspection Chamber is available to inspect?

Rows	Yes	No	Needing repair or installing
Fixed Piping
Flexible Pipe
Sngl Wall Pipe
Dbl Wall Pipe
Pumped?
Gravity?
High Top outlet?
Low Bottom Outlet?
Steel Pipe
Plastic Pipe
Rubber Pipe
Are filters Fitted?
Leak Detection?
Can Nozzle be fixed in an open position?
Tank outlet fitted with a valve?
non Return valve in feed line?

Rows	yes	no	Missing	Needs work carried out
Drainage ways cleared?
Interceptor drains clear?
Are all Correct signage displayed?
does the tank present an immediate environmental risk?
Has pipework been tested in last 5 years?
Has all other pipework been tested in last 10 years?
How Frequently has the bund and pipework been inspected?
Where battery equipment is fitted, is the facility available for electric?

Rows	Yes	No
Check filters and Clean
Grease Locks
Check Calibration
Check Belts for wear
Check Hose for wear
Check Hosereel operation
Check Nozzles for damage / weeps
Check Pigtails/breakaway
Check pump units and air separator
Check internal pipework
Check seals
Check Meter
Check Pulsar Operation
Check Totaliser Operation
Check Displays for wear and water ingress
Check Paintwork
Check Mounting Fittings
Check Keypad on Fuel Monitor
Check bypass operation

Maintenance / Inspection Report