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

Ultrasonic

Purpose:

Scheduled

Prior Inspection
Date:

External

Internal

Unscheduled

Ultrasonic

Internal

Other (Specify)

Tank Specifications
Manufacturer

Contents:

Specific Gravity:

Dimensions:

Capacity

Fill height:

Maximum Operating Temperature(F)

Yes No

Produce Heated?
Tank Construction:
Bare Steel

Double-bottom

Coated Steel
Internally lined bottom

Synthetic liner beneath tank

Concrete secondary
containment

Welded bottom

Riveted bottom

Welded shell

Riveted shell

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________________

Roof

Open

Groundwater Monitoring

Cable Systems

Vapor Monitoring

Visual/Interstitial

Tracer Technologies

Other

Tank Internal

Dike Field

Synthetic Liner

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?

Weld

Plate

 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

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?:
(Year)

External (visual): (Year)

Yes

No

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

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

Internal: (Year) __________________________________________

SIGNATURE(s):
API 653 Inspector / Date:

Florida State Inspector / Date: