DERR-2024-010394

Facility ID#: Facility Name: Inspection Date:
Street Address: City: ZIP:
# of Tanks Inspected: Tank ID Numbers:
Any item marked “No” requires additional information to describe the condition and date the condition is corrected.
ITEM STATUS COMMENTS / DATE CORRECTED
Containment
1 Is the containment structure in satisfactory condition
(diking, impounding, double-wall tank, etc.)?Yes No
2 Are the drainage pipes/valves in good working
condition for continued service?Yes No N/A
Tank Foundation/Supports
3 Free of tank settlement or foundation washout? Yes No
4 Concrete pad or ring wall free of cracking or spalling? Yes No
5 Tank supports in satisfactory condition? Yes No
6 Is water able to drain away from tank? Yes No
7 Is the grounding strap between the tank and
foundation/supports in good condition? Yes No N/A
Cathodic Protection
8 Are cathodic protection system in operating condition
and functional? Yes No N/A
9
Rectifier reading
Volts: ________ Amps: _______
Are these readings within manufacturer
specifications?
Yes No N/A
Tank External Coating
10 Free of visible signs of paint failure? Yes No
Tank Shell / Heads
11 Free of noticeable shell/head distortions, buckling,
denting, or bulging? Yes No
12 Free of visible signs of shell/head corrosion or
cracking? Yes No
Tank Manways, Piping, and Equipment
13 Flanged connection bolts tight and fully engaged with
no sign of wear or corrosion?Yes No N/A
Tank Roof
14 Free of standing water on roof? Yes No
15 Free of visible signs of coating cracking, crazing,
peeling, or blistering? Yes No
16 Free of holes? Yes No
AST Annual Visual Inspection Form Page 1 of 2
ITEM STATUS COMMENTS/DATE CORRECTED
Venting
17 Normal and emergency vents free of obstructions? Yes No
18 Normal vent on tanks storing gasoline equipped with
pressure/vacuum vent cap? Yes No N/A
19 Is the emergency vent in good working condition and
functional, and tested as required by manufacturer? Yes No
Insulated Tanks
20 Free of missing insulation? Yes No N/A
21 Insulation free of noticeable areas of moisture? Yes No N/A
22 Insulation free of mold? Yes No N/A
23 Insulation free of visible signs of damage? Yes No N/A
24 Insulation adequately protected from water
intrusion? Yes No N/A
Level and Overfill Prevention Equipment
25 Electronic or mechanical liquid level gauge tested for
proper operation? Yes No N/A
26 Electronic or mechanical liquid level gauge calibrated
during the previous 12 months? Yes No N/A
27
Is overfill prevention equipment in good working
condition?
Overfill Valve Audible Alarm Both
Yes No N/A
Verified
by:
Inspection
Date:
Operational?
Yes
No
Repair
Date:
28 Is tank ullage being determined and documented
before filling the tank? Yes No N/A
Electrical Equipment
29 Is tank/equipment grounding adequate and in good
condition? Yes No
30 Is electrical wiring for control boxes, lights, and other
high voltage equipment in good condition? Yes No N/A
Additional Comments
Printed Name: Signature: Date:
AST Annual Visual Inspection Form Page 2 of 2
WESTECH EQUIPMENT
LAKE CITY, UTAH 84157-0307
801-266--433--261-4054
PRODUCT PIPING INTEGRITY TESTING
Facility Name: USFWS Jones Hole NFH Owner: USFWS Jones Hole NFH
Address: 24495 East Jones Hole Hatchery Road Address: 1380 South 2350 West
City, State, Zip: Vernal, Utah 84078 City, State, Zip: Vernal, Utah 84078
Facility I.D.#: 9000113 Phone #: [phone]
Testing Company: Westech Phone #: [phone] Date:8/20/24
This procedure is to test the integrity of product piping. Tests were performed with Petro-Tite line tester.
Tank Number 1 1
Product Stored DSL DSL
Piping Run Supply Return
Piping Type Flex D/W Flex D/W
Test Pressure (PSI)15 15
Test Duration (minutes)30 30
Leak Rate (GPH)0.000 0.000
Test Results Pass Fail Pass Fail Pass Fail Pass Fail
Comments:
Taber DeHart, UT-0394