EPA Region 8 Drinking Water Unit Finished Water Storage Tank Inspection/ Cleaning Checklist Fill out one checklist per storage tank & submit labeled photos of each tank component with this form PWS Name: PWS ID: Tank Name: Tank ID: Proposed Inspection Date: Actual Inspection Date: Name of Person Filling Out Form: Title of Person Filling Out Form: I certify that this information is complete and accurate: Date: Inspector Qualifications (answer to all questions must be “yes”) Name and contact information of inspector (if water system personnel) or inspection company: Yes No Has the inspector completed confined space training? Yes No Did the inspector have a confined space entry permit? Overall Tank Condition Proposed Actual Significant Deficiency Required Correction Completion Completion Date Date If no, what repairs are Does the tank appear to be Yes No suggested by the tank structurally sound? inspector? Are there any unprotected openings If yes, indicate type of Yes No in the tank (breaches, leaks, daylight breach and how it should coming through tank in spots, etc) be repaired. Air Vent Proposed Actual Significant Deficiency Required Correction Completion Completion Date Date Above Ground Tanks (Ground Level or Elevated) Check if NA Does the tank have a vent If no, indicate proposed Yes No NA separate from the overflow? correction*: Downturned vent: Is the vent If no reconfigure vent to Yes No NA at least 24” above the roof? provide proper air gap. Non-downturned vent: Is there a solid cover down to If no, indicate deficiency Yes No NA the bottom of the vent and proposed correction: screen? Non-downturned vent: Is the screen at least 8” above the If no, indicate deficiency Yes No NA roof surface? What is the and proposed correction: height of the start of the screening above the tank? Is the vent covered with #24 mesh corrosion resistant If no, indicate deficiency Yes No screening (some exceptions and proposed correction*: apply)? Mesh Size:
EPA Region 8 Drinking Water Unit Finished Water Storage Tank Inspection/ Cleaning Checklist Fill out one checklist per storage tank & submit labeled photos of each tank component with this form PWS Name: PWS ID: Tank Name: Tank ID: Proposed Inspection Date: Actual Inspection Date: Name of Person Filling Out Form: Title of Person Filling Out Form: I certify that this information is complete and accurate: Date: Inspector Qualifications (answer to all questions must be “yes”) Name and contact information of inspector (if water system personnel) or inspection company: Yes No Has the inspector completed confined space training? Yes No Did the inspector have a confined space entry permit? Overall Tank Condition Significant Deficiency Required Correction Proposed Completion Date Actual Completion Date Yes No Does the tank appear to be structurally sound? If no, what repairs are suggested by the tank inspector? Yes No Are there any unprotected openings in the tank (breaches, leaks, daylight coming through tank in spots, etc) If yes, indicate type of breach and how it should be repaired. Air Vent Significant Deficiency Required Correction Proposed Completion Date Actual Completion Date Above Ground Tanks (Ground Level or Elevated) Check if NA Yes No NA Does the tank have a vent separate from the overflow? If no, indicate proposed correction*: Yes No NA Downturned vent: Is the vent at least 24” above the roof? If no reconfigure vent to provide proper air gap. Yes No NA Non-downturned vent: Is there a solid cover down to the bottom of the vent screen? If no, indicate deficiency and proposed correction: Yes No NA Non-downturned vent: Is the screen at least 8” above the roof surface? What is the height of the start of the screening above the tank? If no, indicate deficiency and proposed correction: Yes No Is the vent covered with #24 mesh corrosion resistant screening (some exceptions apply)? Mesh Size: If no, indicate deficiency and proposed correction*:
storage_tank_finished_water_checklist_wyoming.docx