Date: Yes No Site Location: Type of Storage Facility: Treatment Storage (i.e. clearwell) Hydropneumatic Pressure Tank Elevated Storage Tank Ground Storage Tank Diameter/Depth: Height and/or Length: Elevation: Shape: SIZE Capacity (gal): Material (type): Wall Thickness: Cover Thickness: Thickness: Base Construction: Corrosion Control: Interior: Cathodic COATING NSF Approved Yes No Protection? Yes No Size: MANHOLE Overlap 2”? Water Tight? Accessible? Secure? Yes No Yes No Yes No Yes No Turned Down 12”-24” Grade? Yes No OVERFLOW Screened? If Flapper, Screened Inside? Yes No PIPING Splash Pad or Inlet Drainage Structure? Yes No (n/a for pressure tanks) Diameter inches Turned Down 24” Roof or Sod? Yes No VENTS Twenty Four Mesh Non-Corrodible Screen? Yes No (n/a for pressure tanks) Diameter inches Bypass to Out of Service? Yes No Pressure Gauge? Yes No Level Control Equipment? Yes No GENERAL Water Level Indicating Device? Yes No Steel Structures Meet AWWA Standard? Yes No Down-Turned Smooth-Nozzle Sample Tap? Yes No WATER SUPPLY FINISHED WATER STORAGE 2 of 2
Yes No Date: Site Location: Type of Storage Facility: Treatment Storage (i.e. clearwell) Elevated Storage Tank Hydropneumatic Pressure Tank Ground Storage Tank SIZE Diameter/Depth: Height and/or Length: Elevation: Shape: Capacity (gal): Material (type): Wall Thickness: Cover Thickness: Thickness: Base Construction: Corrosion Control: COATING Interior: Cathodic Protection? Yes No NSF Approved Yes No MANHOLE Size: Overlap 2”? Water Tight? Accessible? Secure? Yes No Yes No Yes No Yes No OVERFLOW PIPING (n/a for pressure tanks) Turned Down 12”-24” Grade? Screened? If Flapper, Screened Inside? Splash Pad or Inlet Drainage Structure? Diameter inches Yes No Yes No Yes No VENTS (n/a for pressure tanks) Turned Down 24” Roof or Sod? Twenty Four Mesh Non-Corrodible Screen? Diameter inches Yes No Yes No GENERAL Bypass to Out of Service? Pressure Gauge? Level Control Equipment? Water Level Indicating Device? Steel Structures Meet AWWA Standard? Down-Turned Smooth-Nozzle Sample Tap? Yes No Yes No Yes No Yes No Yes No Yes No WATER SUPPLY FINISHED WATER STORAGE 2 of 2