API 653 Tank Inspection Summary Form

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API 653 Tank Inspection Summary Form
DEP Form # 62-761.900(4)_______________
Florida Department of Environmental Protection
Twin Towers Office Bldg.2600 Blair Stone RoadTallahassee, 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:
Prior Inspection
Date:
Unscheduled


Internal



Ultrasonic
Scheduled

External

Ultrasonic

Internal
Other (Specify)
Tank Specifications
Manufacturer
Contents:
Specific Gravity:
Dimensions:
Capacity
Fill height:
 Yes  No
Produce Heated?
Tank Construction:
Bare Steel

Maximum Operating Temperature(F)


Coated Steel
Internally lined bottom




Synthetic liner beneath tank

Concrete secondary
containment

Welded bottom

Riveted bottom

Welded shell

Riveted shell
Double-bottom
Double-wall
Approved internal
secondary containment
Cathodic Protection
 Galvanic
 Impressed current
Date
Installed_____________
Other secondary
containment_____________
Original thickness________________
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________________



Open
Groundwater Monitoring

Cable Systems
Vapor Monitoring

Visual/Interstitial
Tracer Technologies

Other
Tank Internal




Dike Field

Synthetic Liner
Roof
Internal floating
Umbrella



Fixed
External floating


Cone
Dome
Other
____________________________________________
Release Detection
Tank External
Interstitial monitoring – describe

Concrete

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












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
Weld












Plate












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
























Tank Bottom Inspection Results
Bottom (External)
Minimum Remaining Thickness
Minimum Required Thickness
Maximum Corrosion Rate



Bottom (Internal)



Tank Shell Inspection Results
Shell (External)
Minimum Remaining Thickness
Minimum Required Thickness
Maximum Corrosion Rate



Shell (Internal)



Tank Roof Inspection Results
Fixed
Minimum Remaining Thickness
Minimum Required Thickness
Maximum Corrosion Rate
Floating






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:

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