Aboveground Storage Tank (AST) Environmental Survey
1. Facility Information
Facility Name
Facility Address
City
State
ZIP Code
Contact Person
Contact Phone
2. Tank Information
Tank ID/Number
Location Onsite
Tank Capacity (gallons)
Tank Contents
Tank Material
Installation Date
Last Inspected Date
3. Secondary Containment
Secondary Containment Present
Type of Secondary Containment
Condition of Containment
4. Leak Detection & Monitoring
Leak Detection System Installed
Type of Leak Detection
Inspection Frequency
5. Spills & Releases
Any Spills or Releases in the Past 12 Months
If Yes, Describe
6. Regulatory Compliance
State Permit Obtained
Spill Prevention, Control, and Countermeasure (SPCC) Plan Updated
Other Regulatory Notes
7. Inspection Notes
General Observations
8. Inspector Information
Inspector Name
Date of Inspection