Dep form # 62-761. 900(4) Form Title: Alternative Requirement or Procedure Form Effective Date: July 13, 1998 pi 653 Tank Inspection Summary Form




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Florida Department of Environmental Protection

Twin Towers Office Bldg.2600 Blair Stone RoadTallahassee, Florida 32399-2400



DEP Form # 62-761.900(4)_______________
Form Title: Alternative Requirement or Procedure Form_______
Effective Date: July 13, 1998____________

PI 653 Tank Inspection Summary
Form

Please print or type, fill out all boxes that apply, and attach to API 653 Report




Gerneral Information


Facility Name:

Facility ID#:


Tank location address:


City:

Zip Code:


Phone Number:

Tank Owner/Operator Address:


City:

Zip Code:


Phone Number:

Tank Number:


Construction Date:



Inspection Date__________________________


Type:



External



Ultrasonic



Internal

Purpose:



Scheduled



Unscheduled



Other (Specify)


Prior Inspection

Date:





External



Ultrasonic



Internal



Tank Specifications


Manufacturer


Contents:

Specific Gravity:

Dimensions:

Capacity

Fill height:


Produce Heated?  Yes  No

Maximum Operating Temperature(F)


Tank Construction:



Bare Steel



Double-bottom

Cathodic Protection

 Galvanic



Date Installed_____________



Coated Steel



Double-wall



Internally lined bottom



Approved internal

secondary containment





Synthetic liner beneath tank



Concrete secondary

containment



Other secondary containment_____________






Welded bottom



Riveted bottom

Original thickness________________








Welded shell



Riveted shell

Number of Courses________________

Original Course Thickness: 1.____________ 2.____________ 3.____________ 4.____________

5.____________ 6_____________ 7____________ 8.____________



Foundation



At grade



Concrete pad



Concrete ringwall



Stone ringwall



Oiled sands/soils



Other________________







Roof



Open



Fixed



Cone



Internal floating



External floating



Dome



Umbrella



Other

____________________________________________





Release Detection




Tank External



Groundwater Monitoring



Cable Systems



Vapor Monitoring



Visual/Interstitial



Tracer Technologies



Other

Tank Internal



Interstitial monitoring – describe


Dike Field



Synthetic Liner



Concrete



Other



Tank Bottom Inspection



Non-Destructive Test Method





Weld




Plate

Visual











Ultrasonic (Spot)











Ultrasonic (Scan)











Liquid Penetrant











Penetrating Oil











Magnetic Particle











Radiography











Mag Flux Scan











Vacuum Box











Tracer Gas











Holiday











Other













Tank Shell Inspection



Non-Destructive Test Method





Weld




Plate

Visual











Ultrasonic (Spot)











Ultrasonic (Scan)











Liquid Penetrant











Penetrating Oil











Magnetic Particle











Radiography











Mag Flux Scan











Vacuum Box











Tracer Gas











Holiday











Other












Settlement Evaluation?

 Yes

 No



Tank Roof Inspection



Non-Destructive Test Method





Weld




Plate

Visual











Ultrasonic (Spot)











Ultrasonic (Scan)











Liquid Penetrant











Penetrating Oil











Magnetic Particle











Radiography











Mag Flux Scan











Vacuum Box











Tracer Gas











Holiday











Other













Tank Bottom Inspection Results







Bottom (External)




Bottom (Internal)

Minimum Remaining Thickness











Minimum Required Thickness











Maximum Corrosion Rate













Tank Shell Inspection Results







Shell (External)




Shell (Internal)

Minimum Remaining Thickness











Minimum Required Thickness











Maximum Corrosion Rate













Tank Roof Inspection Results







Fixed




Floating

Minimum Remaining Thickness











Minimum Required Thickness











Maximum Corrosion Rate













Release?




Bottom?



Yes




Shell?



Yes






no









No



Settlement within Tolerance?

Bottom



Yes



No

Differential



Yes



No

Edge



Yes



No

Bulges/Ridges



Yes



No

REPAIR SUMMARY: (Include description, date completed, and date of post-repair inspection)



Foundation:______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________






Bottom:_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________






Shell:__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________






Roof:__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________






Appurtenances:__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________



Hydrostatic test required?:  Yes  No Test date: _______________________

Results: _____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________






INSPECTION SCHEDULE: (Supporting calculations must be available for review upon request)

External (ultrasonic): Corrosion rate known?:  Yes  No

(Year) #1:_____________ #2: _____________ #3: _____________ #4: _____________ #5: _____________




External (visual): (Year) #1:_____________ #2: _____________ #3: _____________ #4: _____________ #5: _____________




Internal: (Year) __________________________________________

SIGNATURE(s):

API 653 Inspector / Date:




Florida State Inspector / Date:



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