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UNIFIED PROGRAM INSPECTION CHECKLIST
Aboveground Petroleum Storage Tank Program
FACILITY NAME
K . X
INSPECTION, DATE
INSPECTION TIME
ADDRESS »
Prepare an SPCC plan [CFR 112.3]
PHONE NO
NO OF EMPLOYEES
FACILITY CONTACT
BUSINESS ID NUMBER
CONSENT TO INSPECT NAME /TITLE
.
s�
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DESCRIPTION
Y
N
N/A
COMMENTS
Prepare an SPCC plan [CFR 112.3]
Review or amend SPCC plan [CFR 112.5 (a)(d)]
.
s�
SPCC plan available on site CFR 112.3(e)]
Conduct inspections and test in accordance with written procedures [CFR 112.7(e)]
Maintain records of inspections, tests and/or procedures [CFR 112.7(e)] �-
Records of inspections or tests signed by inspector [CFR 112.7(e)] >,
1ZF'f'-r1n1U 7- CP('( Plan Flamante, c_mlitnrnia HAaltn K. `iarPry l:nr1P_1 Z!IZIU_4_n_ ZnZ[U. 'IL
DESCRIPTION
`Y
N
N/A
COMMENTS
Self- certification for Tier I or II facility [112.6(a)(1),(b)(1)
Professional engineer certification CFR112.3 d and 112.6(b)(4)
.
s�
Documentation of 5 year review and evaluation of SPCC plan [CFR 112.5(b)]
Amendments required within 6 months of changes/certifications [CFR 112.5(a ) and 112.6(a)(2), (b)(4)]
Management authorization of resource commitment to implement the SPCC [CFR 112.7 & 112.6(a)
Diagram with location and contents of containers, transfer stations, connecting piping 112.7(a)(3)]
Type of oil and storage capacity for each container [CFR 112.7(a)(3)]
`
Discharge prevention measures and procedures for routine handling {CFR 11 2.7(a)(3)
Countermeasures for discovery, response and clean-up CFR112.7(a)(3)]
s,
Required contact list and phone numbers [CFR 112.7(a)(3)],
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DESCRIPTION
Y
NJ
N/A
COMMENTS
Provide corrosion protection [CFR 112.8(c)(4)(5), (d)(1)]
Containers compatible with materials stored, [CFR 112.8(c)(1)
s�
Implement SPCC plan review changes or amendments within 6 months [CFR 112.5(a)(d)
Prepare an oil contingency plan or written control /removal commitments [CFR 112.7(d)]
CFU'TIrIN 4• NP('C_ Plan Ira(ninn• [:alitnrnlA Haa1Tn & %igTP_Tv [:nnP" L!1Lf11.4.5 a'
DESCRIPTION
Y
NJ
N/A
'/'COMMENTS
Training program [CFR 112.7(f)]
Train personnel in operation and maintenance of equipment [CFR 112.7(f)]'
s�
Conduct annuals ill prevention briefings [CFR 112.7(f)(3)]
C1=f_T1(1K1 S- Farilifw Incnafrtinn- r..alitnrnia 14aalth X Sataty C:nr1P• 7577n_a_5
DESCRIPTION
Y
N
NIA
9x COMMENTS
Meet provisions of conditional exemption [H &S 25270.4.5(b)
Facility security adequate [CFR 112.7(g)]
s�
Clean-up materials readily available CFR 112.7(c)]
Overfill protection procedures or devices in place and operative [CFR 112.8(c)(8)]
Portable /mobile containers positioned to prevent discharge CFR 112.8(c)(11)'
Loading / unloading rack drains into containment area CFR 112.7(h)"
Provide appropriate containment /diversionary structures to prevent discharge [CFR 112.8(a), 112.7(c)]
Secondary containment adequate to contain capacity of largest container + precipitation CFR 112.8(c
Remove accumulation of oil in secondary containment [CFR 112.8(c)(10)]
Secondary containment valve(s) closed [CFR 112.8
Implement SPCC plan elements [CFR 112.3]
NY HAZARDOUS WASTE ON SITE? ❑ YES ❑ NO ISignature of] ecei t
xplain:
1101 tS .d
POST INSPECTION INSTRUCTIONS:
• Refer to the back of this inspection report for regulatory citations and corrective actions
• Correct the violation(s) noted above by
• Within 5 days of correcting all of the violations;rsign and retl rn a copy of this page to:
Bakersfield Fire Dept., Prevention Services, 2101 H Street, California 93301
White - Business Copy Yellow - Business Copy to be Sent in after return to Compliance
Signature (that all violations have been corrected as noted)
Date
Pink - Prevention Services Copy
FD2156b (Rev 9/10)