Download - 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
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
Settlement Evaluation? Yes No
Tank Roof 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 Bottom Inspection Results
Bottom (External) Bottom (Internal)
Minimum Remaining Thickness Minimum Required Thickness Maximum Corrosion Rate
Tank Shell Inspection Results
Shell (External) Shell (Internal)
Minimum Remaining Thickness Minimum Required Thickness Maximum Corrosion Rate
Tank Roof Inspection Results
Fixed Floating
Minimum Remaining Thickness Minimum Required Thickness Maximum Corrosion Rate
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: