MONTHLY UST SYSTEM INSPECTION CHECKLIST

Red (R) : Maintenance Required

Green (G) : In Good Condition

Referred Source : www.pei.org/RP900

FID:	188	Contact Number:
Facility Name:	Phillips 66	Contact Email:
Address:	203 N Main St	Date of Inspection:	06/06/2023
Name of the Person Conducting Inspection:		Operator On Duty Name:

Operator Training	Yes / No
Operator Training current.
Operator Notified
Registration/Notification Form	Yes / No
Is Registration current with correct owner,operator etc.
Operator Notified
Release Detection	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Release Dection Method:
Make and Model:
Does it have paper?
Is it Alarm mode?
Interstitial Monitoring Sensor Status Normal
Necessary Monthly Printout Taken
Spill Buckets	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Are spill Buckets Clean and free from water,debris,product etc?
Are the spill Buckets in good condition and free of damage/crocks
Are the Spill Bucket covers in good condition ?

Fill Ports	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Is Fill pipe cap tight and fill pipe free from any obstruction?
Piping/STP Sumps	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Are sumps clean and free from water,debris,product etc?
Under Dispenser Containments(UDC)	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Are UDCs clean and free from water,debris,product etc?
Observation and Monitoring Wells	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Observation Well cover is properly identified and secured
Stage I Vapor Recovery	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
The Spill Containment manhole is clean and free from water, debris, product, etc?
The Spill Containment manhole is free of damage/cracks?
The Spill Containment manhole cover is in good condition?
Is Vapour Adapter cap tight and in good condition ?
Tank Vent Lines	Yes / No	T-1	T-2	T-3	T-4	T-5	T-6
Are the vent lines vertical and firmly supported ?

Operator Notified:

Deficiencies / Discrepencies Note :

Note :

Document :