api 653 tank inspection form

API 653 Tank Inspection Summary FormPlease print or type, fill out all boxes that apply, and attach to API 653 Report

Gerneral InformationFacility 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 InternalPurpose: Scheduled Unscheduled Other (Specify)

Prior Inspection Date:

External Ultrasonic Internal

Tank SpecificationsManufacturer Contents: Specific Gravity:

Dimensions: Capacity Fill height:

Produce Heated? Yes No Maximum Operating Temperature(F)

Tank Construction: Bare Steel Double-bottom Cathodic Protection

Galvanic Impressed currentDate Installed_____________

Coated Steel Double-wall

Internally lined bottom Approved internal secondary containment

Synthetic liner beneath tank Concrete secondarycontainment

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________________

Florida Department of Environmental ProtectionTwin Towers Office Bldg.2600 Blair Stone RoadTallahassee, Florida 32399-2400

DEP Form # 62-761.900(4)_______________

Form Title: Alternative Requirement or Procedure Form_______

Effective Date: July 13, 1998____________

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 OtherTank 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



Settlement Evaluation? Yes No

Tank Roof Inspection



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)


Tank Roof Inspection Results

Fixed Floating


Release?

Bottom? Yes Shell? Yes

no No

Settlement within Tolerance?Bottom Yes NoDifferential Yes NoEdge Yes NoBulges/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:

api 653 tank inspection form

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