Monthly Inspection

Submit 1 Form For Each Tank Inspected

Date *

Technician *

Location *

Tank Number *

Tank Capacity *

Products *

Gasoline Clear Diesel Dyed Diesel Dyed Gasoline

Products - Other

Snow Clearing *

Clear snow from equipment and main walking areas.

Complete N/A

Tank Vent *

Good Poor Replaced N/A

Explain if issues were found with tank vent

6" Emergency Vent *

There are multiple on split compartment tanks.

Good Poor Replaced N/A

Explain if issues were found with 6" emergency vent

Meco Alarm *

Or other overfill protection

Good Poor Replaced N/A

Explain if issues were found with meco alarm

External Tank Shell *

Check for dents, ruptures, or other damage.

Good Poor N/A

Explain if issues were found with external tank shell

Kiosk, Petro Vend & Card Reader *

Check for wear on keypads. Tamper stickers on card reader, and screens for UV damage.

Explain if issues were found with kiosk

Nozzles *

Good Poor Replaced N/A

Explain if issues were found with nozzles

Hoses *

Check for cracks, abrasion, and UV damage.

Good Poor Replaced N/A

Explain if issues were found with hoses

Hose Continuity *

Ensure continuity from Nozzle tip to dispenser outlet. Not just hose ends.

Good Poor Replaced N/A

Explain if issues were found with hose continuity

Breakaways *

Good Poor Replaced N/A

Explain if issues were found with breakaways

Swivels *

Good Poor Replaced N/A

Explain if issues were found with swivels

Crash Protection *

Explain if issues were found with crash protection

Emergency Stop *

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

Explain if issues were found with emergency stop

Fire Extinguishers - Date of Last Annual Inspection *

Dispensers *

Check dispenser sumps for fluids, plumbing for leaks etc.

Good Poor Repaired N/A

Explain if issues were found with dispensers

Micon Batteries *

Turn off head power to dispenser and ensure the screen is flashing.

Good Poor Replaced N/A

Explain if issues were found with micon batteries

Sumps *

Ensure dip sumps are clean, no leaks, and no soiled pads are left in sumps

Good Poor Cleaned N/A

Explain if issues were found with sumps

Spill Kits *

Confirm spill kits contain at least absorbent, gloves, glasses, & rags at minimum.

Explain if issues were found with spill kits

Cleanliness *

Clean it if it's dirty!

Good Poor Cleaned N/A

Explain if issues were found with cleanliness

Generator Cabinet *

Cabinet is free of garbage, fluids, and all doors are operational.

Explain if issues were found with generator cabinet

Lights *

Ensure all lights are working over dispensers, outside kiosk, & inside kiosk.

Good Poor Replaced N/A

Explain if issues were found with lights

Stairs and Hand Rails *

Perform a wiggle test, check over railings on stairs and catwalks.

Good Poor Repaired N/A

Explain if issues were found with stairs and hand rails

Secondary Containment Type *

Manual Dip Pressurized Nano Sensor N/A

Transition Sump

Only applicable at Long Lake location

Good Poor Replaced N/A

Water Finding Paste - 1st Compartment *

Water Finding Paste - 2nd Compartment

Water Finding Paste - 3rd Compartment

Additional Comments

E-Signature *

Monthly Inspection

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