"Annual Handheld Release Detection Equipment Inspection" - Mississippi

Annual Handheld Release Detection Equipment Inspection is a legal document that was released by the Mississippi Department of Environmental Quality - a government authority operating within Mississippi.

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  • Released on June 1, 2019;
  • The latest edition currently provided by the Mississippi Department of Environmental Quality;
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MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY
ANNUAL HANDHELD RELEASE DETECTION EQUIPMENT INSPECTION
➢ This form may be utilized to document adequate operability and serviceability of ALL handheld release detection equipment.
Inspection of Handheld release detection equipment is required to be done by 10/5/2021 and every year thereafter.
UST Facility
Person Conducting Inspection
Facility Name
Facility ID#
Inspector Name
Facility Address
Date of Inspection
MDEQ Hand Held Release Detection Equipment Inspection Procedure
➢ Visually inspect all applicable handheld leak detection equipment used at the facility.
If any answer is “NO” for the equipment being inspected; service, repair, or replacement with equipment is required.
Equipment must be reinspected once service, repair, or replacement has occurred.
Manual Tank Gauging or Manual Statistical Inventory Reconciliation
Inspection Results
☐ Yes ☐ No ☐ NA
All gauge sticks on site are the appropriate length for all USTs on site.
☐ Yes ☐ No ☐ NA
th
All gauge sticks are clearly legible with units on a 1/16
inch scale.
☐ Yes ☐ No ☐ NA
All inadequate sticks have been removed from the facility and disposed of.
Groundwater Monitoring
Inspection Results
☐ Yes ☐ No ☐ NA
All bailers used at this facility are operable and in good condition.
☐ Yes ☐ No ☐ NA
Clear water can easily be seen in the bailer and easily distinguished from product.
☐ Yes ☐ No ☐ NA
All inadequate bailers have been removed from the facility and disposed of.
Vapor Monitoring
rd
All vapor monitoring equipment used for leak detection must be inspected / certified annually by a 3
party.
rd
Certificate of Calibration is required to be provided by the 3
Party.
Company
Evaluator Name
rd
Address
Phone Number
Date of Calibration by 3
party
Owner or Operator
Manufacturer and Model
Serial Number
☐ Yes
☐ No
Third Party Certificate of Calibration attached?
Comments:
PRODUCED BY THE MISSISSIPPI DEPT OF ENVIRONMENTAL QUALITY, OFFICE OF POLLUTION CONTROL, UST BRANCH
PO BOX 2261, JACKSON, MS 39225; PHONE (601) 961-5171; FAX (601) 961-5093; http://www.mdeq.ms.gov
6/2019
MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY
ANNUAL HANDHELD RELEASE DETECTION EQUIPMENT INSPECTION
➢ This form may be utilized to document adequate operability and serviceability of ALL handheld release detection equipment.
Inspection of Handheld release detection equipment is required to be done by 10/5/2021 and every year thereafter.
UST Facility
Person Conducting Inspection
Facility Name
Facility ID#
Inspector Name
Facility Address
Date of Inspection
MDEQ Hand Held Release Detection Equipment Inspection Procedure
➢ Visually inspect all applicable handheld leak detection equipment used at the facility.
If any answer is “NO” for the equipment being inspected; service, repair, or replacement with equipment is required.
Equipment must be reinspected once service, repair, or replacement has occurred.
Manual Tank Gauging or Manual Statistical Inventory Reconciliation
Inspection Results
☐ Yes ☐ No ☐ NA
All gauge sticks on site are the appropriate length for all USTs on site.
☐ Yes ☐ No ☐ NA
th
All gauge sticks are clearly legible with units on a 1/16
inch scale.
☐ Yes ☐ No ☐ NA
All inadequate sticks have been removed from the facility and disposed of.
Groundwater Monitoring
Inspection Results
☐ Yes ☐ No ☐ NA
All bailers used at this facility are operable and in good condition.
☐ Yes ☐ No ☐ NA
Clear water can easily be seen in the bailer and easily distinguished from product.
☐ Yes ☐ No ☐ NA
All inadequate bailers have been removed from the facility and disposed of.
Vapor Monitoring
rd
All vapor monitoring equipment used for leak detection must be inspected / certified annually by a 3
party.
rd
Certificate of Calibration is required to be provided by the 3
Party.
Company
Evaluator Name
rd
Address
Phone Number
Date of Calibration by 3
party
Owner or Operator
Manufacturer and Model
Serial Number
☐ Yes
☐ No
Third Party Certificate of Calibration attached?
Comments:
PRODUCED BY THE MISSISSIPPI DEPT OF ENVIRONMENTAL QUALITY, OFFICE OF POLLUTION CONTROL, UST BRANCH
PO BOX 2261, JACKSON, MS 39225; PHONE (601) 961-5171; FAX (601) 961-5093; http://www.mdeq.ms.gov
6/2019