Date Conducted: / Conducted by:
Safety Equipment / Yes / No / NA / Comments
PPE
Non-vented or indirect-vented chemical splash goggles – 1 per operator plus 1 spare pair required (CGA G-2.1 sec 3.2 & 3.4.6)
NH3 gloves – 1 pair per operator plus 1 spare pair required (CGA G-2.1 sec 3.2 & 3.4.2)
Rain Boots – 1 pair available (CGA G-2.1 sec 3.4.3)
Slicker or protective pants jacket – 1 pair available (CGA G-2.1 sec 3.4.4)
2 emergency escape-only respirators (optional for outdoor facilities) (CGA G-2.1 sec 3.4.1)
Water
Deluge shower or open top tank with 150 gallons of water (CGA G-2.1 sec 3.4.5)
Water clean or shower functioning (CGA G-2.1 sec 3.4.5)
Tank or shower within 100 feet of work area (CGA G-2.1 sec 3.4.5)
Tank or shower is accessible (CGA G-2.1 sec 3.4.5)
Emergency Contact Sign / Yes / No / NA / Comments
Contains phrase “Emergency Information” (CGA G-2.1 sec 6.8)
Contains name of facility (CGA G-2.1 sec 6.8)
Contains 2 contacts with 10-digit phone numbers (CGA G-2.1 sec 6.8)
Emergency contacts & phone numbers accurate (Observation)
Contains phrase “the 911 address is” (CGA G-2.1 sec 6.8)
911 address accurate (Observation)
Letters at least 2” high, legible from 50' (CGA G-2.1 sec 6.8)
Sign at entrance to plant or located near NH3 storage tank (CGA G-2.1 sec 6.8)
Site Conditions / Yes / No / NA / Comments
Areas within 10’ of storage tanks clear of dry grass and other combustible materials (CGA G-2.1 sec 5.3.6)
Facility secured by lighting and locking of storage tank valves when unattended (CGA G-2.1 sec 3.8 & 6.7.1 option)
Vehicle barriers protect storage tank(s) appurtenances (CGA G-2.1 sec 6.7.1)
Road in good condition (CGA G-2.1 sec 5.3.5)
Accessible to emergency vehicles (CGA G-2.1 sec 5.3.5)
Storage tanks 50’ from dug well or potable water source (CGA G-2.1 sec 5.3.2)
Storage tanks meet minimum separation distance as required by AHJ or Table 5 of CGA G-2.1 if installed after 1/1/02 (30,000 gallon or less 100’ from mainline railroad, 50’ from highway or property line, 300’ from residence or place of public assembly and 500’ from institutional occupancy CGA G-2.1 sec 5.3.4)
Are separation distances considered for nurse tank parking areas (100’ from mainline railroad, 25’ from highway or property line, 150’ from residence or place of public assembly and 250’ from institutional occupancy) (CGA G-2.1 sec 5.3.4)
Storage tanks spaced at least 5’ apart (CGA G-2.1 sec 6.4.6)
Storage Tank(s) / Yes / No / NA / Comments
Nameplate legible
Tank Serial Number (CGA G-2.1 sec 5.4.1.1)
Tank Mfg. (CGA G-2.1 sec 5.4.1.1)
ASME code (CGA G-2.1 sec 5.4.1.1)
Year built (CGA G-2.1 sec 5.4.1.1)
Water capacity (gal) (CGA G-2.1 sec 5.4.1.6)
Design Pressure (at least 250 psi) (CGA G-2.1 sec 5.1.1.2, 5.4
1.1 & 6.1)
Design Temperature (F) (CGA G-2.1 sec 5.4.1.1 & 5.4.1.4)
Shell thickness (in) (CGA G-2.1 sec 5.4.1.5)
Head thickness (in) (CGA G-2.1 sec 5.4.1.5)
Overall Length (ft-in) (informational)
Outside Diameter (in) (informational)
Outside surface area (sq ft) (CGA G-2.1 sec 5.4.1.7)
State Agency ID number (informational)
NBN, U-1A or Test Report if installed after November 2014 (CGA G-2.1 sec 5.1.1.1 & 5.1.1.4)
Reflective paint in good condition (CGA G-2.1 sec 5.12)
18” clearance from tank bottom to ground (CGA G-2.1 sec 6.4.1) (36” required in IL except for skid mounted tanks with end connections in which 24” clearance is required)
Saddle around one third tank circumference (CGA G-2.1 sec 6.4.2 BMP)
Storage tank anchored or elevated to protect against floatation if located in a floodplain (CGA G-2.1 sec 6.4.3)
General tank condition (Observation)
No Dents
No gouges
No cracks
No corrosion
No undercuts
No leaks
Tank weld condition (observation)
No head to shell defects
No longitudinal defects
No valve fitting defects
Pad fillet defects
Pressure relief valve
Designed for NH3 (CGA G-2.1 sec 5.8.1)
Marked "AA" or "NH3," open psig, CFM, mfg cat no. (CGA G-2.1 sec 5.8.9)
Set point 250 psi (CGA G-2.1 sec 5.8.5)
Mfg expiration date legible (CGA G-2.1 sec 5.8.9)
Valve within service life (CGA G-2.1 sec 5.8.16)
Unobstructed relief path away from tank (CGA G-2.1 sec 5.8.3 & 5.8.10)
No shutoff valves between tank PRV (CGA G-2.1 sec 5.8.8)
Manifold valve functioning (CGA G-2.1 sec 5.8.14 & 6.3.1)
Rain cap (CGA G-2.1 sec 5.8.3 & 5.8.14)
Weep hole to permit moisture to escape (CGA G-2.1 sec 5.8.3 & 5.8.14)
No leakage (CGA G-2.1 sec 5.8.14)
Gauges
Liquid level gauge or 85% bleeder gauge valve (CGA G-2.1 sec 5.11.1 & 5.11.2)
Liquid level gauges indicate maximum fill level at temperatures between 20 °F 100 °F in increments of 20 °F or less (CGA G-2.1 sec 5.11.2)
0 - 400 psi pressure gauge (CGA G-2.1 sec 6.2)
Temperature Gauge (CGA G-2.1 sec 5.9.3 BMP)
Markings
Legible (CGA G-2.1 sec 6.6.1 & 6.6.2)
“Anhydrous Ammonia” or "Caution - Ammonia" in contrasting letters at least 4" high on both sides of tank or group of tanks (CGA G-2.1 sec 6.6.1)
Hazard warning label per Hazcom 29 CFR 1910.1200 (NFPA diamond) (CGA G-2.1 sec 6.6.2)
Valves labeled “Liquid” and “Vapor” or color coded. (Legend “Orange=Liquid” and “Yellow=Vapor” required in IL)
Pump/Compressor / Yes / No / NA / Comments
Liquid Pump
By-pass valve on discharge (CGA G-2.1 sec 5.10.6.1)
By-pass valve tested annually (MN)
By-pass piping at least as large as by-pass valve leads back to storage tank (CGA G-2.1 sec 5.10.6.1)
Pump equipped with internal by-pass back to suction if flow in by-pass piping can be closed off by a valve (CGA G-2.1 sec 5.10.6.1)
0-400 psi pressure gauge on discharge (CGA G-2.1 sec 5.10.6.2)
Lubricated (Observation)
Strainer on inlet (Mfg’s recommendation)
Vapor Compressor
4-way valve direction arrows legible (Observation)
Crankcase oil checked/changed seasonally (Mfg’s recommendation)
Oil pressure gauge on crankcase (Mfg’s recommendation)
0-400 psi pressure gauge on suction (CGA G-2.1 sec 5.10.7.4)
0-400 psi pressure gauge on discharge (CGA G-2.1 sec 5.10.7.4)
Pressure relief valve (PRV) on discharge (CGA G-2.1 sec 5.10.7.3)
PRV within service life (Observation)
Drainable liquid trap on suction (CGA G-2.1 sec 5.10.7.5)
Liquid trap drained seasonally (Mfg’s recommendation)
Pump & Compressor
Designed for NH3 (CGA G-2.1 sec 5.10.6 & 5.10.7)
250 psi MAWP minimum (CGA G-2.1 sec 5.10.7.1)
Belt aligned (Observation)
Belt tension ¼” to 3/8” flex (Mfg’s recommendation)
Belt guard in place (29 CFR 1910.212)
Mounting bolts secure (Observation)
No leakage (Observation)
Piping / Yes / No / NA / Comments
ASTM A-53 Grade B minimum (CGA G-2.1 sec 5.6.4)
Schedule 80 threaded joints (CGA G-2.1 sec 5.6.4)
Schedule 40 welded joints (CGA G-2.1 sec 5.6.4)
Anchored well supported (CGA G-2.1 sec 5.6.3)
Flex connectors SS double braided, 350 psi WP, 1750 psi burst (CGA G-2.1 sec 5.6.5)
Flex connector angle or offset does not exceed mfg’s specification (e.g. 15° or ½ diameter of piping) (mfg’s recommendations)
Piping protected by an excess flow valve has capacity greater than that of excess flow valve (CGA G-2.1 sec 5.5.4)
Protected from vehicles (CGA G-2.1 sec 5.6.6 & 6.7.1)
Hydrostatic relief valves installed on sections of liquid piping that can be isolated between shutoff valves (CGA G-2.1 sec 5.8.12)
Buried piping evaluated every 5 years (CGA G-2.1 sec 5.6.8)
Aboveground piping painted orange and vapor piping painted yellow or per state code (white in IN)
No leakage (Observation)
Hoses / Yes / No / NA / Comments
Marked "Anhydrous Ammonia, XXX PSIG, Mfg, Year of Mfg" per 5' (CGA G-2.1 sec 5.7.6)
350 psig working pressure, 1,750 psig burst pressure (CGA G-2.1 sec 5.7.3)
Within service life (CGA G-2.1 sec 5.7.8.8)
Free from damage, nicks, cracks, kinks, flat spot or blisters (CGA G-2.1 sec 5.7.8.1, 5.7.8.2, 5.7.8.3 & 5.7.8.4)
Couplers in good condition & operate freely (CGA G-2.1 sec 5.7.8.5)
Hydrostatic relief valve on liquid hose (unless bled off) (CGA G-2.1 sec 5.7.5)
Visual hose inspection documented at least annually (CGA G-2.1 sec 5.7.9)
Truck & rail transfer hoses undergo annual pressure requalification test (CGA G-2.1 sec 5.7.9)
Truck & rail transfer hose assemblies tagged with date (month/year) of last pressure test (CGA G-2.1 sec 5.7.9)
No leakage (CGA G-2.1 sec 5.7.8.7)
Valves / Yes / No / NA / Comments
Storage tank valves
Positive shutoff, designed for NH3 (1/4 turn valves not recommended) (CGA G-2.1 sec 5.5.11 & 5.6.5)
Located as close to tank as possible (CGA G-2.1 sec 5.5.3)
Equipped with locking devices (CGA G-2.1 sec 3.8 & 6.7.1 option)
Vapor valves painted yellow or per state code (labeled in IN, IL)
Liquid valves painted orange or per state code (labeled in IN, IL)
No leakage (Observation)
Excess flow/internal valve
Designed for NH3, properly sized & oriented (CGA G-2.1 sec 5.5.4, 5.5.9 & 5.6.5)
Located at tank(s) & risers (CGA G-2.1 sec 5.5.7, 5.5.11, 5.10.8 & 6.2)
Labeled with mfg. capacity, catalog number (CGA G-2.1 sec 5.5.10)
Internal valves closed when not in operation (CGA G-2.1 sec 6.2)
No leakage (Observation)
Remote access emergency shutoff valves
Designed for NH3 & properly oriented (CGA G-2.1 sec 5.6.5 & Observation)
Operate Freely (CGA G-2.1 sec 5.10.8.1 & Observation)
Cable Secure (CGA G-2.1 sec 5.10.8.1 & Observation)
2 actuators located at least 25 feet apart in opposing directions (IL)
System tested regularly (i.e. monthly CGA G-2.1 sec 5.10.8.1, annual documented testing required in IL)
No leakage (Observation)
Flow Valves
Designed for NH3 (CGA G-2.1 sec 5.6.5)
Vapor painted yellow or per state code (labeled if capable of discharging to atmosphere IN)
Liquid painted orange or per state code (labeled if capable of discharging to atmosphere IN)
No leakage (Observation)
Electrical / Yes / No / NA / Comments
Panel condition
Switches functioning & labeled (29 CFR 1910.303(f)(1))
Starter contacts functioning & labeled (29 CFR 1910.303(f)(1))
Breakers functioning & labeled (29 CFR 1910.303(f)(1))
Panel box closes, no open knockouts in box or faceplate, & capable of being locked (29 CFR 1910.303(b)(7), (f)(4) & 1910.305(b)(1))
Conduit condition
No broken conduit or exposed wiring (29 CFR 1910.303(b)(7)(iv))
Protected from vehicle & foot traffic (29 CFR 1910.303(g)(1))
Transport Unload / Yes / No / NA / Comments
Emergency shutoff valve in vapor line within 5’ or reasonable distance of where hose attaches to fixed piping (CGA G-2.1 sec 5.10.8.1)
Emergency shutoff or backflow check valve in liquid line within 5’ or reasonable distance of where hose attaches to fixed piping (CGA G-2.1 sec 5.10.8.1)
Valves capped (Observation)
Pull-away protection designed in accordance with CGA G-2.1 sec 5.10.8.1 (e.g. bulkhead, break-away device, shear fitting) employed (CGA G-2.1 sec 5.10.8.1)
Bleed off system (IA, IL)
Valves designed for NH3 (CGA G-2.1 sec 5.6.5)
No leakage (Observation)
Hoses designed for NH3 (CGA G-2.1 sec 4.4.1 & 5.7.4)
Water tank of adequate size - 1gal H2O per 1lb NH3 (CGA G-2.1 sec 4.4.1)
Ammonia vented near bottom of water tank (Observation)
Water condition not saturated (<35% NH3) (Observation)
Nurse Tank Risers / Yes / No / NA / Comments
Work platform at riser unless nurse tanks/applicators equipped with work platform designed for loading (IA, IL, ND)
Platform free of obstacles (29 CFR 1910.22(a)(1))
Riser valves or hose-ends locked (CGA G-2.1 sec 3.8 & 6.7.1 option)
Pull-away protection designed in accordance with CGA G-2.1 sec 5.10.8.1 (e.g. bulkhead, break-away device, shear fitting) employed (CGA G-2.1 sec 5.10.8.1)
Operating Procedures / Yes / No / NA / Comments
Written operating procedures applicable to facility
Normal/Initial startup (40 CFR 68.52)
Normal shutdown (40 CFR 68.52)
Emergency shutdown (40 CFR 68.52)
Startup after emergency shutdown (40 CFR 68.52)
Filling nurse tanks using pump (Informational)
Filling nurse tanks using compressor (Informational)
Filling transport using pump (Informational)
Filling transport using compressor (Informational)
Injecting N-Serve or other nitrogen stabilizer (Informational)
Unloading transports (Informational)
Unloading railcars using compressor (Informational)
Making ammonium polyphosphate (T-reactor) (Informational)
Making suspension fertilizer (Informational)
Evacuating nurse tanks using compressor (Informational)
Daily equipment inspections (40 CFR 68.52)
Temporary operations (40 CFR 68.52)
Operating procedures contain consequences of deviations and steps to avoid them (40 CFR 68.52)
Employee/driver present during transfer operations (CGA G-2.1 sec 5.10.2)
Training / Yes / No / NA / Comments
Employees trained on ammonia safety (CGA G-2.1 sec 3.1, 11.6.1 & 12.4.1)
Employees trained on SOP’s (CGA G-2.1 sec 3.1, 8.4.3, 11.6.1 & 12.4.1)
Employees trained on EAP or ERP (CGA G-2.1 sec 3.1, 3.3.1 11.6.1 & 12.4.1)
Employees trained on Hazcom (29 CFR 1910.1200(h))
Employees trained on maintenance procedures (40 CFR 68.56)
Ammonia safety refresher training at least once every 3 years (CGA G-2.1 sec 3.1, 40 CFR 68.54, annually IA, ND)
Employees receive appropriate DOT hazmat training (general awareness, function specific, safety, security awareness, in-depth security, driver) for job functions (CGA G-2.1 sec 3.3.4.1 & 3.3.4.2)
Maintenance / Yes / No / NA / Comments
Facility implemented procedures to maintain the mechanical integrity of equipment (40 CFR 68.56)
Only competent contractors or employees are utilized for maintenance of the facility (40 CFR 68.56)
Fixed plant & nurse tanks inspected at least annually (CGA G-2.1 sec 5.7.9 & 5.8.14)
Maintenance records retained for at least 5 years (40 CFR, 68.200)
Emergency Planning / Yes / No / NA / Comments
Facility preplan/coordinated with emergency responders (FD, LEPC, Law Enforcement) (CGA G-2.1 sec 3.3.2 & 8.4.2)
Facility aware of reporting requirements to NRC, SERC & LEPC for releases over 100 lb (CGA G-2.1 sec 3.3.3.1)
Facility submit annual Tier II report to SERC, LEPC & FD for NH3 (CGA G-2.1 sec 3.3.3.2)
Facility has EAP per 29 CFR 1910.38 or ERP per 29 CFR 1910.120 (CGA G-2.1 sec 3.3.4.1)
Facility has conducted SVA & implemented DOT SSP per 49 CFR 172.800 (CGA G-2.1 sec 3.3.4.1, & 3.8)
Facility has submitted CFATS Top Screen Survey per 6 CFR Part 27 (CGA G-2.1 sec 3.3.4.1)
Facility has reliable communication system (CGA G-2.1 sec 3.4.7)
General / Yes / No / NA / Comments
Except for testing, containers (nurse tanks, storage tanks, etc.) only pressurize with ammonia vapor (CGA G-2.1 sec 5.10.3)
Has facility considered and/or taken steps to detect or monitor releases (40 CFR 68.67(3))
Past hazard review findings resolved (40 CFR 68.50(c))
Last inspection by outside agency (Informational)
Glossary of Terms