GROUND LEVEL PRESSURE TANK INSPECTION REPORT

Water System Name & Number:

Station/Tank Name:	Date:

Design Capacity:	Effective Capacity:

Last Inspection Date:	Inspection Frequency:

Last Drained & Cleaned Date:	Next Scheduled Cleaned Date:

SECURITY	YES	NO	N/A	Comments
Signs of trespassing or vandalism?
Fence, cage and/or access ladder locked?
Ability to bypass?
Tank operations linked to SCADA?
Pressure gauge within 10% of SCADA reading?

SPECIAL COMPONENTS	YES	NO	N/A	Comments
ASME name plate attached to tank?
Air compressor equipped with filter?
Sight glass functional?
Pressure/air relief valve(s) functional?
Pressure switch set points:	On: psi Off: psi

EXTERIOR SHELL	YES	NO	N/A	Comments
Holes or openings visible?
Paint or coating cracked or peeled?
Rust spots or stains?
Excessive dirt or debris?
Access port available?
Other damages to structure?
Cathodic protection access plates watertight?
Cathodic protection system last inspection date:
Last maintenance, coating and/or paint date:

INTERIOR ROOF, SIDE SHELL & FLOOR	YES	NO	N/A	Comments
Paint coating cracked or peeled?
Rust spots or stains?
Sediment deposits on side shell, floor and/or ladder?
Air to water ratio between 1:1 and 1:2?
Bladder in good condition?
Last maintenance, coating and/or paint date:
TREES AND VEGETATION	YES	NO	N/A	Comments
Overhanging tree limbs?

FINISHED WATER SUPPLY	YES	NO	N/A	Comments
Dust, debris and/or floaters?
Odor?
Oil on surface?
Free and/or total chlorine residual level:

OVERALL CONDITION OF TANK:	POOR	GOOD	EXCELLENT

DOCUMENTS AVAILABLE:	AS-BUILT PLANS PHOTO/VIDEO O/M RECORDS LAT/LONG

PHOTOS – Please see attached document for the types of photos to include.

COMMENTS & RECOMMENDATIONS:

Inspector Name & Title:

Inspector Signature & Date:

Form provided to:	Division of Drinking Water District Office