Weekly Inspection

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Weekly Inspection

Submit 1 Form For Each Tank Inspected

Date *

YYYY

Technician *

Bonyun, Jon

Braun, Mathew

Gould, Dave

Kirk, Brad

Lewis, Josh

Mitchell, Corey

Ouellet, Colin

Sheppard, Thomas

Wilkins, Mitch

Other:

Location *

Tank Number *

Tank Capacity *

Products *

Gasoline

Clear Diesel

Dyed Diesel

Dyed Gasoline

Other:

Required

Snow Clearing *

Clear snow from equipment and main walking areas.

Complete

N/A

Tank Vent *

Good

Poor

Replaced

N/A

Explain if issues were found with tank vent

6” Emergency Vent *

There are multiple on split compartment tanks.

Good

Poor

Replaced

N/A

Explain if issues were found with emergency vent.

Meco Alarm *

Or other overfill protection

Good

Poor

Replaced

N/A

Explain if issues were found with Meco alarms.

External Tank Shell *

Check for dents, ruptures, or other damage.

Good

Poor

N/A

Explain if issues were found with tank shell

Kiosk, Petro Vend & Card Reader *

Check for wear on keypads. Tamper stickers on card reader, and screens for UV damage.

Good

Poor

Cleaned

Repaired

N/A

Explain if issues were found with kiosk

Nozzles *

Good

Poor

Replaced

N/A

Explain if issues were found with nozzles

Hoses *

Check for cracks, abrasion, and UV damage.

Good

Poor

Replaced

N/A

Explain if issues were found with hoses

Hose Continuity *

Ensure continuity from Nozzle tip to dispenser outlet. Not just hose ends.

Good

Poor

Replaced

N/A

Explain if issues were found with hose continuity.

Breakaways *

Good

Poor

Replaced

N/A

Explain if issues were found with breakaways

Swivels *

Good

Poor

Replaced

N/A

Explain if issues were found with swivels.

Crash Protection *

Good

Poor

Replaced

Repaired

N/A

Explain if issues were found with crash protection.

Emergency Stop *

If the ESD button does not shut down generator, card in and ensure pump does not engage.

Good

Poor

Replaced

Repaired

N/A

Explain if issues were found with ESD

Fire Extinguishers *

ENTER DATE OF LAST ANNUAL INSPECTION

YYYY

Dispensers *

Check dispenser sumps for fluids, plumbing for leaks etc.

Good

Poor

Repaired

N/A

Explain if issues were found with dispensers.

Micon Batteries *

Turn off head power to dispenser and ensure the screen is flashing.

Good

Poor

Replaced

N/A

Explain if issues were found with micon batteries.

Sumps *

Ensure dip sumps are clean, no leaks, and no soiled pads are left in sumps

Good

Poor

Cleaned

N/A

Explain if issues were found with sumps.

Spill Kits *

Confirm spill kits contain at least absorbent, gloves, glasses, & rags at minimum.

Good

Poor

Restocked

Replaced

N/A

Explain if issues were found with spill kits

Cleanliness *

Clean it if it's dirty!

Good

Poor

Cleaned

N/A

Explain if extensive cleaning was required.

Generator Cabinet *

Cabinet is free of garbage, fluids, and all doors are operational.

Good

Poor

Repaired

Cleaned

N/A

Explain if issues were found with generator cabinet.

Lights *

Ensure all lights are working over dispensers, outside kiosk, & inside kiosk.

Good

Poor

Replaced

N/A

Explain if issues were found with lights

Stairs and Hand Rails *

Perform a wiggle test, check over railings on stairs and catwalks.

Good

Poor

Repaired

N/A

Explain if issues were found with stairs or hand rails.

Secondary Containment Type *

Manual Dip

Pressurized

Nano Sensor

N/A

Transition Sump

Only applicable at Long Lake location

Good

Poor

Replaced

N/A

Clear selection

Water Finding Paste - 1st Compartment *

Amount of water found in centimeters.

Water Finding Paste - 2nd Compartment

Amount of water found in centimeters.

Water Finding Paste - 3rd Compartment

Amount of water found in centimeters.

Additional Comments

E-Signature *

Type Full Name

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