Base Plant Monthly Inspection

Submit 1 Form For Each Tank Inspected

Date *

Technician *

Location *

Tank Number *

Unit ID of Asset if Available

Tank Capacity *

Check ULC Plate

Products *

Gasoline Clear Diesel Dyed Diesel Dyed Gasoline

Products - Other

Tank Vent *

Good Poor Replaced N/A

6" Emergency Vent *

Good Poor Replaced N/A

Overfill Alarm *

Good Poor Replaced N/A

External Tank Shell *

Visual inspection

Good Poor Replaced N/A

Kiosk *

Good Poor Replaced N/A

Nozzles *

Perform Anti-Drain & Anti Siphon Test

Good Poor Replaced N/A

Load Arm / API Fittings *

Check over API and arm swivels for leaks.

Good Poor Replaced N/A

Hoses *

Visual inspection

Good Poor Replaced N/A

Hose Continuity *

Check hose for continuity from end to end.

Good Poor Replaced N/A

Breakaways *

Good Poor Replaced N/A

Nozzle Swivels *

Good Poor Replaced N/A

Crash Protection *

Check that barriers or crash bars are in place and not damaged.

Good Poor Replaced N/A

Emergency Stop *

If the ESD button does not shut down generator, card in and ensure pump does not engage.

Good Poor Replaced N/A

Fire Extinguishers *

Check tags for annual inspections.

Good Poor Replaced N/A

Dispensers *

Ensure equipment is functioning correctly.

Good Poor Replaced N/A

Perform segment test on display.

Good Poor Replaced N/A

Micon Batteries *

Note pump number (if any) of dead battery in additional comments section

Good Poor Replaced N/A

Sumps *

Good Poor Replaced N/A

Spill Kits *

Good Poor Replaced N/A

Fill Port & Plumbing *

Good Poor Replaced N/A

Cleanliness *

Good Poor Replaced N/A

Generator Cabinet *

Good Poor Replaced N/A

Lights *

Good Poor Replaced N/A

Burp Tank *

Good Poor Replaced N/A

Stairs and Hand Rails *

Good Poor Replaced N/A

Secondary Containment *

Good Poor N/A

Connected Scaffolding *

Good Poor N/A

Water Finding Paste - 1st Compartment

Water Finding Paste - 2nd Compartment

Water Finding Paste - 3rd Compartment

Additional Comments

E-Signature

Base Plant Monthly Inspection

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