HomeMy WebLinkAboutAST 2017UNIFIED PROGRAM INSPECTION CHE
KLIST
Aboveground Petroleum Storage Tank rogram
FACILITY NAME
INSPECTION DATE
INSPECTION TIME
`� t') v; 12 K L l v\3 CI I •� ;.. '. r tug.
l..l� . `"
`-, r f
ADDRESSy
PHONE NO.
NO OF EMPLOYEES
-Prepare
Review or amend SPCC plan [CFR 112.5 (a)(d)]
k,
FACILITY CONTACT
BUSINESS ID NUMBER
rV-) Al tam'-_ C { i '_;1
X
r "'- C: z t E,
CONSENT TO INSPECT NAME /TITLE
Conduct inspections and test in accordance with written procedures [C
R 112.7(e)]
CCf TIr1A1 01 • DnnArria 1?n11in'Le1' r'alitr% nm H021th IG- -?.ti21PEAtV I :nf101 7!11 /I)
DESCRIPTION
Y
N
N/A
COMMENTS
an SPCC plan CFR 112.3]
r
-Prepare
Review or amend SPCC plan [CFR 112.5 (a)(d)]
k,
�C
SPCC plan available on site [CFR 112.3(e)]
2.5(a)(d)]
X
Conduct inspections and test in accordance with written procedures [C
R 112.7(e)]
Maintain records of inspections, tests and/or procedures CFR 112.7(e)
112.7 & 112.6(a)
Records of inspections or tests signed by inspector [CFR 112.7(e)]
I
�C
CCf`TInKI 7• CDr'r' Dl�n Flnmantc• r'alitr%min Haaltltlx tiat0TV [:nrIP_' 7!17 /ll_4_h_ Z`1Z 11J_1Z
DESCRIPTION
Y
N
N/A
COMMENTS
Self- certification for Tier I or H facility [ 1 12.6(a)(1),(b)(1)]
r
Professional engineer certification [CFR 112.3(d ) and 11 2.6(b) 4
k,
Documentation of 5 year review and evaluation of SPCC plan [CFR 112.5(b) ]
2.5(a)(d)]
X
Amendments required within 6 months of changes/certifications [CFR 112.5(a)
uid 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
in 112.7(a)(3)
% ,,
of oil and storage capacity for each container [CFR 1 12.7(a)(3)
itation [CFR 112.8(c)]
-Type
Discharge prevention measures and procedures for routine handling {CFR 112.
(a)(3)
X
Countermeasures for discovery, response and clean-up [CFR 1 12.7(a)(3)]
x
Required contact list and phone numbers [CFR 112.7(a)(3)
SECTION 3: General SPGG Ke ulrements: c;aurornla meann & ,-)arez Voue; A0A1U.'r+.10, c;)ceu.0 c;)Aiu. 1L
DESCRIPTION
Y
N
N/A
COMMENTS
Provide corrosion protection [CFR 112.8(c)(4)(5), (d)(1)]
r
Containers compatible with materials stored CFR 112.8(c)(1)
k,
SPCC plan review changes or amendments within 6 months CFR 1
2.5(a)(d)]
X
-Implement
Prepare an oil contingency plan or written control/removal commitments [CFR I
12.7(d)]
eef%rinll A• QDf+f% Dl -nn Tr�ininrr• r`!alifnrnin Nanlfh R Rnfafv r_nfla• 7-9;77A -d_5
DESCRIPTION
Y
N
N/A
COMMENTS
program CFR 112.7(f)]
-Training
Train personnel in operation and maintenance of equipment [CFR 112.7(f)]
Conduct annuals ill prevention briefings [CFR 112.7(f)(3)]
)]
X
SECTION 5: Facility Inspection: cautornla Heann & 5 Tety uoue, zazru.4.*
DESCRIPTION Y N N/A COMMENTS
Meet provisions of conditional exemption [H &S 25270.4.5(b)
Facility security adequate [CFR 112.7( )]
Clean-up materials readily available CFR 11 2.7(c)
Overfill protection procedures or devices in place and operative CFR 11 2.8(c)( )
)]
Portable /mobile containers positioned to prevent discharge CFR 112.8(c)(11)
/ unloading rack drains into containment area [CFR 11 2.7(h)]`
-Loading /
FR 112.8(a), 112.7(c)] °
°
containment adequate to contain capacity of largest container + pre ci i
itation [CFR 112.8(c)]
-Secondary c
Secondary containment valve(s) closed [CFR 112.8]
Implement SPCC plan elements [CFR 112.3]
ANY HAZARDOUS WASTE ON SITE ?,XYES ❑ NO S
Si natureofRecei t
Explain:
i
POST INSPECTION INSTRUCTIONS:
• Refer to the back of this inspection report for regulatory citations and correc i
ive actions
ers 1e rp
Date
White - Business Copy Yellow - Business Copy to be Sent in after return to Compliance Pink - Prevention Services Copy
FD2156b (Rev 9/10)
r