"Annual Walkthrough Inspection Checklist Log" - Georgia (United States)

Annual Walkthrough Inspection Checklist Log is a legal document that was released by the Georgia Department of Natural Resources - a government authority operating within Georgia (United States).

Form Details:

  • Released on September 1, 2018;
  • The latest edition currently provided by the Georgia Department of Natural Resources;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Georgia Department of Natural Resources.

ADVERTISEMENT
ADVERTISEMENT

Download "Annual Walkthrough Inspection Checklist Log" - Georgia (United States)

Download PDF

Fill PDF online

Rate (4.8 / 5) 29 votes
Page background image
GA EPD UST
ANNUAL WALKTHROUGH INSPECTION CHECKLIST LOG FOR YEAR
Questions on how to complete this form should be directed to the USTMP (404) 362-2687
Facility Name:
Owner:
Address:
Address:
City, County, Zip:
City, State, Zip:
Facility I.D. #:
Phone #:
Inspector Name:
Inspector Phone #:
Inspector Company:
Instructions
1.
This form allows you to record up to 5 GA EPD UST Tank Numbers, assuming that the Facility ID Number remains the same.
2.
Complete portion of form pertaining to type of equipment inspected for each tank.
3.
Inspection must be performed in accordance with a nationally recognized code of practice (such as PEI RP-900, or equivalent),
manufacturer’s instructions, or GA EPD requirements.
4.
Keep a record copy of this inspection for 3 years.
GA EPD Tank ID #
Product Stored
Containment Sump Inspection
 sub pump
 sub pump
 sub pump
 sub pump
 sub pump
Type of containment sump
 intermediate
 intermediate
 intermediate
 intermediate
 intermediate
inspected
 dispenser
 dispenser
 dispenser
 dispenser
 dispenser
 yes
 yes
 yes
 yes
 yes
Visually checked sump for
 no
 no
 no
 no
 no
damage?
 yes
 yes
 yes
 yes
 yes
Integrity of both walls of double
 no
 no
 no
 no
 no
walled sump verified by checking
 n/a
 n/a
 n/a
 n/a
 n/a
interstitial space for leaks?
 yes
 yes
 yes
 yes
 yes
Sump checked for leaks of water
 no
 no
 no
 no
 no
or fuel into the containment area?
 yes
 yes
 yes
 yes
 yes
Water, fuel and/or debris found in
 no
 no
 no
 no
 no
sump?
 yes
 yes
 yes
 yes
 yes
Water, fuel and/or debris removed
 no
 no
 no
 no
 no
from sump and disposed of
 n/a
 n/a
 n/a
 n/a
 n/a
properly?
 yes
 yes
 yes
 yes
 yes
Visually checked sump for any
 no
 no
 no
 no
 no
releases to the environment?
 yes
 yes
 yes
 yes
 yes
All penetrations (boots, conduits,
 no
 no
 no
 no
 no
etc.) into sump in good condition?
Piping interstitial space open to
 yes
 yes
 yes
 yes
 yes
sump to allow piping leak of
 no
 no
 no
 no
 no
product to enter sump?
 yes
 yes
 yes
 yes
 yes
Sensors positioned properly
 no
 no
 no
 no
 no
near bottom of sump?
 yes
 yes
 yes
 yes
 yes
Visible piping in good condition?
 no
 no
 no
 no
 no
Inspector’s initials and
/
/
/
/
/
/
/
/
/
/
date inspected
Hand Held Release Detection Equipment Inspection
 gauge stick
 gauge stick
 gauge stick
 gauge stick
 gauge stick
 groundwater
 groundwater
 groundwater
 groundwater
 groundwater
Type of hand held release
detection equipment
bailer
bailer
bailer
bailer
bailer
 other (specify):
 other (specify):
 other (specify):
 other (specify):
 other (specify):
 pass
 pass
 pass
 pass
 pass
Results of operability and
 fail
 fail
 fail
 fail
 fail
serviceability Inspection
Inspector’s initials and
/
/
/
/
/
/
/
/
/
/
date inspected
Repairs Needed
Date of Repair
Description of any Repairs
GA EPD 9/2018
GA EPD UST
ANNUAL WALKTHROUGH INSPECTION CHECKLIST LOG FOR YEAR
Questions on how to complete this form should be directed to the USTMP (404) 362-2687
Facility Name:
Owner:
Address:
Address:
City, County, Zip:
City, State, Zip:
Facility I.D. #:
Phone #:
Inspector Name:
Inspector Phone #:
Inspector Company:
Instructions
1.
This form allows you to record up to 5 GA EPD UST Tank Numbers, assuming that the Facility ID Number remains the same.
2.
Complete portion of form pertaining to type of equipment inspected for each tank.
3.
Inspection must be performed in accordance with a nationally recognized code of practice (such as PEI RP-900, or equivalent),
manufacturer’s instructions, or GA EPD requirements.
4.
Keep a record copy of this inspection for 3 years.
GA EPD Tank ID #
Product Stored
Containment Sump Inspection
 sub pump
 sub pump
 sub pump
 sub pump
 sub pump
Type of containment sump
 intermediate
 intermediate
 intermediate
 intermediate
 intermediate
inspected
 dispenser
 dispenser
 dispenser
 dispenser
 dispenser
 yes
 yes
 yes
 yes
 yes
Visually checked sump for
 no
 no
 no
 no
 no
damage?
 yes
 yes
 yes
 yes
 yes
Integrity of both walls of double
 no
 no
 no
 no
 no
walled sump verified by checking
 n/a
 n/a
 n/a
 n/a
 n/a
interstitial space for leaks?
 yes
 yes
 yes
 yes
 yes
Sump checked for leaks of water
 no
 no
 no
 no
 no
or fuel into the containment area?
 yes
 yes
 yes
 yes
 yes
Water, fuel and/or debris found in
 no
 no
 no
 no
 no
sump?
 yes
 yes
 yes
 yes
 yes
Water, fuel and/or debris removed
 no
 no
 no
 no
 no
from sump and disposed of
 n/a
 n/a
 n/a
 n/a
 n/a
properly?
 yes
 yes
 yes
 yes
 yes
Visually checked sump for any
 no
 no
 no
 no
 no
releases to the environment?
 yes
 yes
 yes
 yes
 yes
All penetrations (boots, conduits,
 no
 no
 no
 no
 no
etc.) into sump in good condition?
Piping interstitial space open to
 yes
 yes
 yes
 yes
 yes
sump to allow piping leak of
 no
 no
 no
 no
 no
product to enter sump?
 yes
 yes
 yes
 yes
 yes
Sensors positioned properly
 no
 no
 no
 no
 no
near bottom of sump?
 yes
 yes
 yes
 yes
 yes
Visible piping in good condition?
 no
 no
 no
 no
 no
Inspector’s initials and
/
/
/
/
/
/
/
/
/
/
date inspected
Hand Held Release Detection Equipment Inspection
 gauge stick
 gauge stick
 gauge stick
 gauge stick
 gauge stick
 groundwater
 groundwater
 groundwater
 groundwater
 groundwater
Type of hand held release
detection equipment
bailer
bailer
bailer
bailer
bailer
 other (specify):
 other (specify):
 other (specify):
 other (specify):
 other (specify):
 pass
 pass
 pass
 pass
 pass
Results of operability and
 fail
 fail
 fail
 fail
 fail
serviceability Inspection
Inspector’s initials and
/
/
/
/
/
/
/
/
/
/
date inspected
Repairs Needed
Date of Repair
Description of any Repairs
GA EPD 9/2018