API 653 Tank Inspection Form

DEP Form # 62-761.900(4)_______________ 

 Florida Department Department of Environmental Environmental Protection Protection Twin Towers Office Bldg. •2600 Blair Stone Road•Tallahassee, Florida 32399-2400

Form Title: Alternative Requirement or Procedure Form_______  Effective Effective Date: 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________________ 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 Pr 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: ____________  _________________ __________ ___________ ___________ ___________ ____________ ___________ __________ __________ ___________ ____________ ____________ ___________ ___________ ____________ ____________ __________  ____  _________________________________________________________________________________________________________ 

Hydr Hydros osta tati tic c test test requ requir ired ed?: ?:

Yes Yes

No

Test Test date: date: ____ ______ ____ ____ ____ ____ ____ ____ ____ ____ ___  _ 

Results: _______________________________________________________________________________________________________________  _______________________________________________________________________________________________________________ 

INSPECTION SCHEDULE: SCHEDULE: (Supporting calculations must be available for review upon request) External (ultrasonic): Corrosion Corro sion rate known?:

Yes

No

(Year)

#1:_____________ #2: _____________ #3: _____________ #4: _____________ #5: _____________ 

External (visual): (Year) (Year)

#1:__________ #1:_____________ ___ #2: #2: ____________ _____________ _ #3: ________ _____________ _____ #4: __________ _____________ ___ #5: #5: ___________ _____________  __ 

Internal: (Year) __________________________________________  SIGNATURE(s): API 653 Inspector / Date:

Florida State Inspector / Date: