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UNIFIED PROGRAM INSPECTION CHECKLIST
Aboveground Petroleum Storage Tank Program
FACILITY NAME
YJ
INSPECTION DATE
-'r -t2
INSPECTION TIME
ADDRESS
Prepare an SPCC plan [CFR 112.31
PHONE NO. NO OF EMPLOYEES
Review or amend SPCC plan [CFR 112.5 (a)(d)]
BUSINESS ID NUMBER
FACILITY CONTAC
SPCC plan available on site [CFR 112.3(e)]
C - SENT TO INSPECT N+ ME /TITLE
Conduct inspections and test in accordance with written procedures [CFR 112.7(e)
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DESCRIPTION
YJ
N
N/A
COMMENTS
Prepare an SPCC plan [CFR 112.31
I.Y.
Review or amend SPCC plan [CFR 112.5 (a)(d)]
'
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 1 12.7(e)]
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Y N
N N
-
COMMENTS
Self - certification fo T' r II facility 112.6(a)(1),(b)(1)
Professional engineer certification CFR112.3(d and 112.6(b)(4)
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 112.7(a)(3)] .
.
Countermeasures for discovery, response and clean-up [CFR112.7(a)(3)]
Required contact list and phone numbers CFR 112.7(a)(3)
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DESCRIPTION Y N N/A COMMENTS
Provide corrosion protection [CFR 112.8(c)(4)(5), (d)(1)] V.
Containers compatible with materials stored [CFR 112.8(c)(1)] r
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) ]
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DESCRIPTION YJ N N/A COMMENTS
Meet provisions of conditional exemption [H &S 25270.4.5(b
Facility security adequate [CFR 112.7(g)]
Clean-up materials readily available [CFR 112.7(c)] '`
Overfill protection procedures or devices in place and operative CFR 112.8(c)(8) X
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) °rte
Secondary containment valve(s) )closed [CFR 112.8] '
Implement SPCC plan elements CFR 112.3]'
NY HAZARDOUS WASTE ON SITE? ❑ YES ,2 NO Si Lynature ofRecei t
xplain:
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, sign and return a copy of this page to:
Bakersfie 1AV 1 eF t., Prevention Services, 2101 H Street, California 93301
Date
Pink- Prevention Services Copy
Signature (that all violations have been corrected as noted)
White - Business Copy Yellow - Business Copy to be Sent in after return to Compliance
FD2156b (Rev 9/10)
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DESCRIPTION YJ N N/A COMMENTS
Meet provisions of conditional exemption [H &S 25270.4.5(b
Facility security adequate [CFR 112.7(g)]
Clean-up materials readily available [CFR 112.7(c)] '`
Overfill protection procedures or devices in place and operative CFR 112.8(c)(8) X
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) °rte
Secondary containment valve(s) )closed [CFR 112.8] '
Implement SPCC plan elements CFR 112.3]'
NY HAZARDOUS WASTE ON SITE? ❑ YES ,2 NO Si Lynature ofRecei t
xplain:
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, sign and return a copy of this page to:
Bakersfie 1AV 1 eF t., Prevention Services, 2101 H Street, California 93301
Date
Pink- Prevention Services Copy
Signature (that all violations have been corrected as noted)
White - Business Copy Yellow - Business Copy to be Sent in after return to Compliance
FD2156b (Rev 9/10)
NY HAZARDOUS WASTE ON SITE? ❑ YES ,2 NO Si Lynature ofRecei t
xplain:
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, sign and return a copy of this page to:
Bakersfie 1AV 1 eF t., Prevention Services, 2101 H Street, California 93301
Date
Pink- Prevention Services Copy
Signature (that all violations have been corrected as noted)
White - Business Copy Yellow - Business Copy to be Sent in after return to Compliance
FD2156b (Rev 9/10)