Form AG-01314 "Anhydrous Ammonia Storage Facility Inspection Checklist" - Minnesota

What Is Form AG-01314?

This is a legal form that was released by the Minnesota Department of Agriculture - a government authority operating within Minnesota. As of today, no separate filing guidelines for the form are provided by the issuing department.

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  • Released on March 27, 2019;
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625 ROBERT STREET NORTH, SAINT PAUL, MN 55155–2538
WWW.MDA.STATE.MN.US
Pest and Fertilizer Management, Ph: 651–201–6275, Fx: 651–201–6117
MINNESOTA STATUTE §18.D.201
Anhydrous Ammonia Storage Facility Inspection Checklist
Firm Name (As Licensed or Producer):
Location (City/State):
Date:
INSTRUCTIONS: UNLESS OTHERWISE NOTED, specify non–compliance by entering “(X)” in the boxes or next to item number.
PERIODIC INSPECTION REQUIRED– MN Rules 1513.0180, Subpart 13., requires that pressure relief devices (PRDs — hydrostats and pressure relief valves) receive a periodic visual external inspection to determine that PRDs: (A.) are free of
evidence of tampering, damage, corrosion, or foreign matter that might prevent proper operation: (B.) are free of leakage when subject to pressures below the minimum allowable start to discharge setting: (C.) has a properly secured rain cap or
other device to avoid entry of moisture or other matter into the relief valve outlet: and (D.) has an open weep hole to permit moisture to escape (weep holes – only for pressure relief valves)
MN CITATION
SITE IDENTIFICATION / LICENSING / RIGHT TO KNOW TRAINING
SAFETY EQUIPMENT (1513.0040)
1. LEGIBLE SIGN AT SITE WITH SITE ID, ADDRESS, PHONE #’S OF SITE AND AFTER
1513.0380
6. TWO FULL FACE NH3–RATED GAS MASKS REQUIRED
HOURS STAFF.
7. FOUR CURRENTLY DATED NH3–RATED CANISTERS REQUIRED
18C.415
2. CURRENT FERTILIZER LICENSE AND FERTILIZER LICENSE POSTING REQUIRED
CANISTER DATES:
8. PAIR NH3–RATED GLOVES AND GOGGLES REQUIRED
3. IRP – INCIDENT RESPONSE PLAN REQUIRED
9. PAIR NH3–IMPERVIOUS RAINSUIT / SLICKER / BOOTS REQUIRED
IRP UPDATED EVERY 3 YEARS AND DOCUMENTED.
18C.235
10. SAFETY EQUIPMENT NOT ACCESSIBLE AND MAINTAINED
IRP REVIEWED WITH EMPLOYEES ONCE/CALENDAR YEAR AND DOCUMENTED
11. ACCESSIBLE DELUGE SHOWER + PLUMBED EYE WASH OR A MINIMUM OF 150+
IRP MADE AVAILABLE TO LOCAL RESPONDERS AND DOCUMENTED.
GALLON CLEAN WATER IN AN OPEN TOP CONTAINER REQUIRED
1513.0040
4. NH3 SAFETY & COMPETENCY TRAINING REQUIRED
12. ARE GLOVES/GOGGLES WORN WHEN HANDLING NH3 AND DURING MAINTENANCE
1513.0340
5. IF TWO+ TANKS; TANKS MUST BE AT LEAST 5 FT APART
TANKS IDENTIFICATION / LOCATION
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
13. Clean area within 10 ft. of tank(s) of weeds,
combustible materials, and materials not required
1513.0130
for facility operation and access to emergency
personnel and vehicles.
Nos. 15 – 18; Sides of each tank or outer sides of a group of tanks
TANK PAINTING / MARKINGS / PLACARDING
14. Tank(s) requires painting
1513.0220
15. “Anhydrous Ammonia” 4–inch letters
1513.0360
16. “Inhalation Hazard” 4–inch letters
1513.0360
17. “1005” placards
1513.0360
18. Guaranteed grade analysis; one area per tank
1513.0360
19. System openings ID required for liquid / vapor phases
1513.0140
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
TANK NAMEPLATE DATA & NON–CODE WELDING
20. Tank manufacturer
1513.0140
ASME construction code symbols
1513.0140
1513.0140
Tank Serial No. & Contract No.
1513.0140
National Board No.
1513.0140
Year or Date Built
1513.0140
Plant Manufactured
1513.0140
Tank PSI Rating @ °F
ºF =
ºF =
ºF =
ºF =
1513.0140
Overall length (OL) & Outside diameter (OD)
OL=
OD.=
OL=
OD.=
OL=
OD.=
OL=
OD.=
Tank Gallonage Sq. Ft. Area &
Gallonage=
Gallonage=
Gallonage=
Gallonage=
1513.0140
CFM Required (See #61)
Sq. Ft.=
CFM=
Sq. Ft.=
CFM=
Sq. Ft.=
CFM=
Sq. Ft.=
CFM=
1513.0140
Head and shell metal thickness (inches)
Hd=
Shell=
Hd=
Shell=
Hd=
Shell=
Hd=
Shell=
1513.0120
21. Non–code welding on tank
R = Repair
RP = Replace
TANK FOUNDATION / SUPPORTS / SADDLE CONTACTS (1513.0340)
22. Foundation / Support type - Concrete (C), Metal (M), Skid (SK), etc.
Supports:
Foundation:
Supports:
Foundation:
Supports:
Foundation:
Supports:
Foundation:
23. Tank foundation (F) / supports (S) R or RP required. Saddle support
corrosion protection contacts (SC) requires R or RP.
24. Saddle supports covers at least 1/3 circumference of newly installed /
relocated tank
25. Tank bottom at least 18 inches from ground level?
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
TANK APPURTERANCES
1513.0140
26. 85% fixed liquid level gauge–operates properly, etc.
1513.0140
27. Float/mechanical liquid level gauge
% liquid level=
% liquid level=
% liquid level=
% liquid level=
1513.0320
28. 0–400 PSI / NH3–rated pressure gauge
PSI=
PSI=
PSI=
PSI=
1513.0190
29. Temperature Gauge
ºF =
ºF =
ºF =
ºF =
Main Liq.
GPM=
GPM=
GPM=
GPM=
30. Excess Flow Valve
Liq. Return
GPM=
GPM=
GPM=
GPM=
1513.0320
before each shutoff
valve in tank
Vapor
GPM=
GPM=
GPM=
GPM=
PIPING & PIPING APPURTERANCES (System)
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
1513.0160
31. NH3–rated pipe/fittings required
1513.0160
32. Eliminate leaks in system
1513.0160/.0370
33. Traffic protection (tanks, piping, etc.)
1513.0160
34. Provision for expansion/contraction required
1513.0150
35. Main tank shut-off valves installed correctly?
36. Main tank valves closed/locked OR closed/securely
1513.0370
fenced when facility is unattended.
continued on page 2
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651–201–6000.
AG–01314
TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
3/27/19
Page 1 of 2
625 ROBERT STREET NORTH, SAINT PAUL, MN 55155–2538
WWW.MDA.STATE.MN.US
Pest and Fertilizer Management, Ph: 651–201–6275, Fx: 651–201–6117
MINNESOTA STATUTE §18.D.201
Anhydrous Ammonia Storage Facility Inspection Checklist
Firm Name (As Licensed or Producer):
Location (City/State):
Date:
INSTRUCTIONS: UNLESS OTHERWISE NOTED, specify non–compliance by entering “(X)” in the boxes or next to item number.
PERIODIC INSPECTION REQUIRED– MN Rules 1513.0180, Subpart 13., requires that pressure relief devices (PRDs — hydrostats and pressure relief valves) receive a periodic visual external inspection to determine that PRDs: (A.) are free of
evidence of tampering, damage, corrosion, or foreign matter that might prevent proper operation: (B.) are free of leakage when subject to pressures below the minimum allowable start to discharge setting: (C.) has a properly secured rain cap or
other device to avoid entry of moisture or other matter into the relief valve outlet: and (D.) has an open weep hole to permit moisture to escape (weep holes – only for pressure relief valves)
MN CITATION
SITE IDENTIFICATION / LICENSING / RIGHT TO KNOW TRAINING
SAFETY EQUIPMENT (1513.0040)
1. LEGIBLE SIGN AT SITE WITH SITE ID, ADDRESS, PHONE #’S OF SITE AND AFTER
1513.0380
6. TWO FULL FACE NH3–RATED GAS MASKS REQUIRED
HOURS STAFF.
7. FOUR CURRENTLY DATED NH3–RATED CANISTERS REQUIRED
18C.415
2. CURRENT FERTILIZER LICENSE AND FERTILIZER LICENSE POSTING REQUIRED
CANISTER DATES:
8. PAIR NH3–RATED GLOVES AND GOGGLES REQUIRED
3. IRP – INCIDENT RESPONSE PLAN REQUIRED
9. PAIR NH3–IMPERVIOUS RAINSUIT / SLICKER / BOOTS REQUIRED
IRP UPDATED EVERY 3 YEARS AND DOCUMENTED.
18C.235
10. SAFETY EQUIPMENT NOT ACCESSIBLE AND MAINTAINED
IRP REVIEWED WITH EMPLOYEES ONCE/CALENDAR YEAR AND DOCUMENTED
11. ACCESSIBLE DELUGE SHOWER + PLUMBED EYE WASH OR A MINIMUM OF 150+
IRP MADE AVAILABLE TO LOCAL RESPONDERS AND DOCUMENTED.
GALLON CLEAN WATER IN AN OPEN TOP CONTAINER REQUIRED
1513.0040
4. NH3 SAFETY & COMPETENCY TRAINING REQUIRED
12. ARE GLOVES/GOGGLES WORN WHEN HANDLING NH3 AND DURING MAINTENANCE
1513.0340
5. IF TWO+ TANKS; TANKS MUST BE AT LEAST 5 FT APART
TANKS IDENTIFICATION / LOCATION
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
13. Clean area within 10 ft. of tank(s) of weeds,
combustible materials, and materials not required
1513.0130
for facility operation and access to emergency
personnel and vehicles.
Nos. 15 – 18; Sides of each tank or outer sides of a group of tanks
TANK PAINTING / MARKINGS / PLACARDING
14. Tank(s) requires painting
1513.0220
15. “Anhydrous Ammonia” 4–inch letters
1513.0360
16. “Inhalation Hazard” 4–inch letters
1513.0360
17. “1005” placards
1513.0360
18. Guaranteed grade analysis; one area per tank
1513.0360
19. System openings ID required for liquid / vapor phases
1513.0140
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
TANK NAMEPLATE DATA & NON–CODE WELDING
20. Tank manufacturer
1513.0140
ASME construction code symbols
1513.0140
1513.0140
Tank Serial No. & Contract No.
1513.0140
National Board No.
1513.0140
Year or Date Built
1513.0140
Plant Manufactured
1513.0140
Tank PSI Rating @ °F
ºF =
ºF =
ºF =
ºF =
1513.0140
Overall length (OL) & Outside diameter (OD)
OL=
OD.=
OL=
OD.=
OL=
OD.=
OL=
OD.=
Tank Gallonage Sq. Ft. Area &
Gallonage=
Gallonage=
Gallonage=
Gallonage=
1513.0140
CFM Required (See #61)
Sq. Ft.=
CFM=
Sq. Ft.=
CFM=
Sq. Ft.=
CFM=
Sq. Ft.=
CFM=
1513.0140
Head and shell metal thickness (inches)
Hd=
Shell=
Hd=
Shell=
Hd=
Shell=
Hd=
Shell=
1513.0120
21. Non–code welding on tank
R = Repair
RP = Replace
TANK FOUNDATION / SUPPORTS / SADDLE CONTACTS (1513.0340)
22. Foundation / Support type - Concrete (C), Metal (M), Skid (SK), etc.
Supports:
Foundation:
Supports:
Foundation:
Supports:
Foundation:
Supports:
Foundation:
23. Tank foundation (F) / supports (S) R or RP required. Saddle support
corrosion protection contacts (SC) requires R or RP.
24. Saddle supports covers at least 1/3 circumference of newly installed /
relocated tank
25. Tank bottom at least 18 inches from ground level?
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
TANK APPURTERANCES
1513.0140
26. 85% fixed liquid level gauge–operates properly, etc.
1513.0140
27. Float/mechanical liquid level gauge
% liquid level=
% liquid level=
% liquid level=
% liquid level=
1513.0320
28. 0–400 PSI / NH3–rated pressure gauge
PSI=
PSI=
PSI=
PSI=
1513.0190
29. Temperature Gauge
ºF =
ºF =
ºF =
ºF =
Main Liq.
GPM=
GPM=
GPM=
GPM=
30. Excess Flow Valve
Liq. Return
GPM=
GPM=
GPM=
GPM=
1513.0320
before each shutoff
valve in tank
Vapor
GPM=
GPM=
GPM=
GPM=
PIPING & PIPING APPURTERANCES (System)
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
1513.0160
31. NH3–rated pipe/fittings required
1513.0160
32. Eliminate leaks in system
1513.0160/.0370
33. Traffic protection (tanks, piping, etc.)
1513.0160
34. Provision for expansion/contraction required
1513.0150
35. Main tank shut-off valves installed correctly?
36. Main tank valves closed/locked OR closed/securely
1513.0370
fenced when facility is unattended.
continued on page 2
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651–201–6000.
AG–01314
TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
3/27/19
Page 1 of 2
PIPING & PIPING APPURTERANCES (System)
STORAGE TANK 1
STORAGE TANK 2
STORAGE TANK 3
STORAGE TANK 4
1513.0160
37. Non–code welding on NH3 piping
38. List area(s) between each pair of liquid and vapor shutoff valves LACKING 350–400 PSI / NH3–RATED HYDROSTAT (S), CLEANING (C), RAINCAP (RC)
1513.0180
1513.0180
39. Periodic inspection required – on all hydrostatic relief valves in storage system piping/valves, nurse tank risers, and other NH3 transfer areas. Refer to the top of page 1 for instructions.
PUMPING / COMPRESSOR / METER SYSTEM APPURTERANCES
1513.0200
40. Compressor and/or pump/size, pump inlet and outlet piping:
Discharge side of liquid pump before or near the pressure actuated bypass valve/line
q
1513.0200
41. 0-400 PSI / NH3-rated pressure gauge and compressor PRV
Both sides of compressor
Dirty or out of condition PRV and/or defective/missing rain cap
q
q
PSID: (Bypass PSI – Static PSI)
42. ANNUAL TEST REQUIRED (Every 12 months):
Bypass ID:
Bypass PSI:
Static PSI:
External pressure actuated (PA) bypass system installed at
PSID: (Bypass PSI – Static PSI)
the discharge side of pump(s) must take the full flow capacity
Bypass ID:
Bypass PSI:
Static PSI:
of the pump at a safe pressure differential (PSID) and without
1513.0200
undue stress on pump(s)/motor(s).
Any undue stress/pulldown on pump(s) & motor(s) during the PA bypass system test?
Refer to MDA Fact Sheet, Procedure for Testing Pressure
Actuated Bypass System. Place test data (i.e. Bypass PSI,
Static PSI and PSID) in adjacent boxes/spaces.
1513.0200
43. Manual bypass: Must be closed during normal operations (filling nurse tanks, etc.) to allow full/compliant operation of pressure actuated bypass.
1513.0200
44. Meter(s)
250 psi/NH3 rated and
Equipped to prevent measurement of vapor
q
q
NURSE TANK LOADING RISERS
RISER IDENTIFICATION / LOCATION
Liquid
Type =
Pipe size =
45. Circle each riser valve without a
1513.0200
properly sized excess flow value
Vapor
Type =
Pipe size =
Note in #46 if Fisher Snappy Joe Emergency Shutoff Valve does not have an extra outer spring Emergency shut-off valve (ESV) with bulkhead = ESVB; Tripod = T; other shear/weakness fittings = SW
46. Type of required pull away device
Liquid
1513.0200
Circle pull away device that is NOT
Vapor
adequate - Impeded, leaky, etc.
47. Periodic inspection required –
Liquid
Each hose riser NOT protected with
1513.0180
a 350-400 PSI hydrostat:
Vapor
Cleaning (C); Rain cap (RC)
Liquid
1513.0180
48. NH3–rated hose out of condition
1513.0310
Vapor
49. When facility is unattended: (a). Hose–end valve(s) locked
out;(b). Unable to remove hose-end valve(s) from lockout(s); and
1513.0370
(c). Unable to operate hose-end valve(s) in lockout(s).
(Lockouts not required if facility is securely fenced when
unattended.)
1513.0370
50. Traffic Protection for riser area(s)
RAIL & CARGO TANK (TRANSPORT) UNLOADING AREA:
RAIL UNLOADING AREA
CARGO TANK (TRANSPORT) UNLOADING AREA
If Present - Note in #’s 51 & 52 if Fisher Snappy Joe Emergency Shutoff Valve (ESV) does not have an extra outer spring
Location:
Location:
51. Liquid unload piping requires backcheck (BC) or
1513.0200
other suitable flow protection (Excludes ESV’s)
52. Vapor unload requires properly sized excess flow valve or
1513.0200
other suitable flow protection (Excludes ESV’s)
53. Periodic inspection required – Liquid & vapor unload
Liquid:
Vapor:
Liquid:
Vapor:
Liquid:
Vapor:
1513.0180
hose(s) requires 350-400 PSI / NH3-rated hydrostat(s);
Cleaning (C); Rain cap (RC)
1513.0170
54. NH3 rated hoses for unload area out of condition
Liquid:
Vapor:
Liquid:
Vapor:
Liquid:
Vapor:
55. Type of required cargo tank (transport) area pull-away
protection (i.e. bulkhead, weakness/shear fittings). Circle if
1513.0200
NOT adequate or impeded – i.e. transport transfer hosing
catches on fencing, etc
56. Rail = Caution signs required for placement on tracks to warn of connections?
Rail = Wheel chokes required for use in unloading car(s)?
1513.0640
1513.0200
57. Non Permitted Storage: Rail Tank cars and Cargo Tank (transport) being loaded from or unloaded into an approved/permitted fixed storage facility
MANIFOLDS & PRESSURE RELIEF VALVES – PRV’S – PERIODIC INSPECTION REQUIRED (1513.0180 & 1513.0330)
TANK IDENTIFICATION / MANIFOLD & PRV LOCATION
58. Brand of manifold(s) (C = Continental; RD/RM
1513.0330
= Rego Duoport/Multiport; ST = Squibb Taylor)
1513.0330
59. R/RP manifold(s) – Properly operates?
60. UL CFM/Air rating of manifold(s)
1513.1100
61. CFM required/tank (See #20)
1513.0180
62. Up / down stream restrictions
1513.0370
ID / LOCATION OF PRV’S
63. PRV Brand (C = Continental; RL/RS =
1513.0180
Rego–large/small; ST = Squibb Taylor)
64. Periodic inspection required –
1513.0180
Refer to the top of page 1 for instructions.
1513.1100
65. CFM rating of PRV’s
1513.0180
66. PRV’s NH3 and 250 PSI–rated
1513.0180
67. PRV Installation records maintained
1513.0180
68. Replace out–of–date / out–of–condition PRV
1513.0180
69. PRV Cleaning (C); Raincap (RC) Required
In accordance with the Americans with Disabilities Act, this information is available in alternative forms of communication upon request by calling 651–201–6000.
AG–01314
TTY users can call the Minnesota Relay Service at 711. The MDA is an equal opportunity employer and provider.
3/27/19
Page 1 of 2
Page of 2