Monthly Inspection Report Example #1

Any item found defective shall be addressed or repaired within 30 days. All repairs shall be recorded in the completed inspection report with details as to how such defect was resolved. Completed monthly inspection reports shall be kept in this binder for 3 years.

Y means “Defect” and N means “No Defect” / Y* / N / Description & Comment
Any problems with vent risers
Any problems with pressure/vacuum vent caps
Any problems with the spill buckets
Any problems with the piping containment sumps
Any problems with the under-dispenser containment sumps
Inspect dry break poppet valves to ensure that each such valve forms a continuous seal, including but not limited to ensuring that each valve depresses evenly across the valve seat and that it reseats properly
Inspect fuel dispenser hoses to ensure that there are no tears, leaks, holes, kinks, crimps or defects of any kind
Any problems with the dispenser cabinet interiors
Cathodic protection system Rectifier current ______/ Rectifier voltage ______
Inspect transfer and dispensing areas to ensure that any release has been reported and cleaned in accordance with all applicable federal, state, and local requirements
Inspect and test leak and product monitoring device alarm enunciation panels to ensure the proper operation of leak and product monitoring and detection systems
Should any oil, water, or debris be discovered in any secondary containment component of any UST of UST system, such oil, water, or debris shall be removed and disposed in accordance with all applicable federal, state, and local requirements.
Security Y means “Defect” and N means “No Defect” Y N
Fence
Fill ports locked
Spill Kit Inventory Need? Y N
Other Y N

Inspection Month/Year ______Signature:______

Date: ______Name:______