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
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 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:_____________________________________________________________________________________________________
__

_____________________________________________________________________________________________________

__

Hydrostatic test required?:

Yes

No

Test date: _______________________

Results: ___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

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

Yes

No

(Year)

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

External (visual): (Year)

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

Internal: (Year) __________________________________________

SIGNATURE(s):
API 653 Inspector / Date:

Florida State Inspector / Date: