SPCC Annual Tank Assessment Form

Area:	Date:

Inspector Name (Signature)	Supervisor Name (Signature)

Tanks
Yes/No	Comment
Signs of leakage	Yes No
Tank condition ok	Yes No
Foundation condition ok	Yes No
Gauges/alarms working properly	Yes No

Containment Area
Yes/No	Comment
Signs of oil in containment area	Yes No
Cracks in containment	Yes No
Drainage valves/openings closed	Yes No

Transfer Operations
Yes/No	Comment
Signs of leakage from pipes, valves, flanges	Yes No
Pipeline condition ok	Yes No
Out-of-service pipes capped	Yes No

Truck Loading and Unloading Areas
Yes/No	Comment
Signs of leaks/spills	Yes No
Warning signs posted or wheel chocks used	Yes No

Security
Yes/No	Comment
Lighting functioning properly	Yes No
Fences and gates intact	Yes No
Gates locked when facility is unattended	Yes No

For instructions, refer to Appendix D.1 in your SPCC Plan.

NDOT Form 160, August 17