Sertek Form_______________

Form Title: Alternative Requirement or Procedure

Form_______
Effective Date: ____________

API 653 Tank Inspection Summary Form

Please print or type, fill out all boxes that apply, and attach to API 653 Report
Gerneral Information
Facility 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  Internal
Purpose:  Scheduled  Unscheduled  Other (Specify)

Prior Inspection  External  Ultrasonic  Internal

Date:

Tank Specifications
Manufacturer Contents: Specific Gravity:

Dimensions: Capacity Fill height:

Produce Heated?  Yes  No Maximum Operating Temperature(F)

Tank Construction:
 Bare Steel  Double-bottom Cathodic Protection
 Coated Steel  Double-wall  Galvanic
 Internally lined bottom  Approved internal  Impressed current
secondary containment Date
Installed_____________
 Synthetic liner beneath tank  Concrete secondary Other secondary
containment 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________________
 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  Other
Tank 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  No
Differential  Yes  No
Edge  Yes  No
Bulges/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:

Site Inspector / Date: