DEP Form # 62-761.
900(4)_______________
Florida Department of Environmental Protection
Twin Towers Office Bldg.2600 Blair Stone RoadTallahassee, Florida 32399-2400
Form Title: Alternative Requirement or Procedure
Form_______
Effective Date: July 13, 1998____________
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
Purpose:
Scheduled
Prior Inspection
Date:
External
Ultrasonic
Unscheduled
Internal
Other (Specify)
Ultrasonic
Internal
Tank Specifications
Manufacturer
Contents:
Specific Gravity:
Dimensions:
Capacity
Fill height:
Produce Heated?
Yes
No
Tank Construction:
Bare Steel
Coated Steel
Internally lined bottom
Maximum Operating Temperature(F)
Double-bottom
Double-wall
Approved internal
secondary containment
Synthetic liner beneath tank
Concrete secondary
containment
Welded bottom
Riveted bottom
Cathodic Protection
Galvanic
Impressed current
Date
Installed_____________
Other secondary
containment_____________
Original thickness________________
Welded shell
Riveted shell
Number of
Courses________________
Original Course Thickness: 1.____________ 2.____________ 3.____________ 4.____________
5.____________ 6_____________ 7____________ 8.____________
Foundation
At grade
Stone ringwall
Concrete pad
Oiled sands/soils
Concrete ringwall
Other________________
Roof
Open
Internal floating
Umbrella
Fixed
Cone
External floating
Dome
Other
____________________________________________
Release Detection
Tank External
Tank Internal
Groundwater Monitoring
Vapor Monitoring
Tracer Technologies
Interstitial monitoring describe
Dike Field
Synthetic Liner
Concrete
Cable Systems
Visual/Interstitial
Other
Other
Tank Bottom Inspection
Non-Destructive Test Method
Visual
Ultrasonic (Spot)
Ultrasonic (Scan)
Liquid Penetrant
Penetrating Oil
Magnetic Particle
Radiography
Mag Flux Scan
Vacuum Box
Tracer Gas
Holiday
Other
Weld
Plate
Weld
Plate
Tank Shell Inspection
Non-Destructive Test Method
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
Visual
Ultrasonic (Spot)
Ultrasonic (Scan)
Liquid Penetrant
Penetrating Oil
Magnetic Particle
Radiography
Mag Flux Scan
Vacuum Box
Tracer Gas
Holiday
Other
Weld
Plate
Bottom (External)
Bottom (Internal)
Shell (External)
Shell (Internal)
Fixed
Floating
Tank Bottom Inspection Results
Minimum Remaining Thickness
Minimum Required Thickness
Maximum Corrosion Rate
Tank Shell Inspection Results
Minimum Remaining Thickness
Minimum Required Thickness
Maximum Corrosion Rate
Tank Roof Inspection Results
Minimum Remaining Thickness
Minimum Required Thickness
Maximum Corrosion Rate
Release?
Bottom?
Yes
no
Settlement within Tolerance?
Bottom
Differential
Edge
Bulges/Ridges
Shell?
Yes
Yes
Yes
Yes
Yes
No
No
No
No
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:
