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Quarterly Inspection Checklist
Dipenser Fueling Point#'s 1 2 3 4 5 6 7 8 9 10 11 12
Check for leaks --- --- --- --- --- --- --- --- --- --- --- ---
Check hoses --- --- --- --- --- --- --- --- --- --- --- ---
Check nozzles --- --- --- --- --- --- --- --- --- --- --- ---
Check breakways --- --- --- --- --- --- --- --- --- --- --- ---
Check nozzle cover splash guards --- --- --- --- --- --- --- --- --- --- --- ---
Check regulatory and octane decals --- --- --- --- --- --- --- --- --- --- --- ---
Are dispensers anchored --- --- --- --- --- --- --- --- --- --- --- ---
Is dispenser containment free of products/water/debris? --- --- --- --- --- --- --- --- --- --- --- ---
Is fire extinguisher charged and dated? --- --- --- --- --- --- --- --- --- --- --- ---
Tank/Tank Monitor Regular Midgrade Premium Diesel
On Need Maint On Need Maint On Need Maint On Need Maint
Check M/H covers and fill caps, verify all 4" caps have gaskets and are liquied light ------------------------
Check spill buckets for cracks ------------------------
Check vent caps ------------------------
Check drop tubes and over fill valves ------------------------
Are all probes operational and calibrate correctly? ------------------------
Are STP Containements free of product/water/debris? ------------------------
Are fills/vapor recovery free of product/water/debris? ------------------------
verify the test boots for the D/W are not blocking liquid access into the sump? ------------------------
YesNoN/A
Check for presence of overfill ---------
Is overfill alarm functioning properly? ---------
Is tank monitor time set corrrectly? ---------
Is E-stop operational and at least 20' but no more then 100' from dispensers? ---------
General Items YesNo
Does inrercom function at all islands? ------
Current tank registration certificate present on site ? ------
Tank registration information correct? ------
Annuaul Requirments YesNoN/ADate of Last Test
Impact valve tested? ------------
Leak detector tested(No electonic leak detection)? ------------
If electronic leak detection 1,2, or 3 test being ran? ------------
ElectronicManualSensorsDate of Last Test
Method of line testing ------------
Method of tank testing? ------------
Corrosion Systems YesNoN/ADate of Last 3 Year Inspection
Galvanic : Anoode test records current? (Must be conducted every 3 years)(The previous 2 inspections must be available) ------------
Impressed Current : Rectifier functional today? ------------
Impressed Current : Readings recorded on schedule?(every 60 days)(The previous 3 readings are required the previous 2 inspections must be available ) ------------
Leak Detection Systems YesNoN/A
Has each alarm condition been responded to appropriately? (Record comments below) ---------
DESIGNATED B OPERATOR :
ALTERNATE B OPERATOR :
Signature :
Printed Name :
Candidate ID:
Signature :
Printed Name :
Candidate ID:
Data Reviewed & Approved By Designated B Operator :
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