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Section 8: Corrosion Protection

[ ] Applicable [ ] Not Applicable

Tank #___

Pip __

Tank #___

Pip __

Tank #___

Pip __

Tank #___

Pip __

Tank #___

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Tank #___

Pip __

Tank #___

Pip __

Tank #___

Pip __

Tank #___

Pip __

Tank #___

A buried metal tank and piping (including fittings, flex-connectors, etc.) must be isolated from soil and cathodically protected. Commercial Heating Oil UST systems installed after March 15, 1985 require corrosion protection.

Non-Metal Construction passes inspection. Questions 1 and 2 are (P) or (PC) Go to Section 9

1

2

Non-Metal Construction Material Answer (P)ass, (PC), (F)ail or (NA) for

each tank and pipe Tank: Outer wall made of non-metallic material such as fiberglass or plastic jacket or coating. Pipe: Outer wall made of non-metallic material such as fiberglass or flexible plastic.

Galvanic Cathodic Protection passes inspection. Questions 3 – 6 are (P) or (PC) or 6 (NA)

N/A

N/A

N/A

N/A

N/A

N/A

  • #

    Check () type of corrosion protection for each tank and pipe, and answer

    • (P)

      ass, (PC), (F)ail or (NA) for each tank and pipe

N/A

N/A

N/A

N/A

3

3a. 4

5

6

Galvanic Cathodic Protection (Tank and Piping) Tank: CP on (sti-P3®) tested within past 3 years and passed test in accordance with NACE Code of Practice Standard. If supplemental anodes were installed or added, complete 3a. UST CP tested annually. N/A N/A

Pipe: CP tested within past year and passed test in accordance with NACE Code of Practice Standard. Record of last two cathodic protection tests on file with Owner or Operator. Cathodic protection system failure was inspected/repaired within 60 days of test.

N/A

Pip __

N/A

Pip __

N/A

N/A

7 8 9 10

Impressed Current Cathodic Protection (Tank and Piping) Date impressed current system installed. (M/Y).

Assessment performed at 5-year intervals. System has power and is turned on. Hour meter present? If (Y) complete 11.

(Circle one)

(Circle one)

Y/N

Y/N

(Circle one)

(Circle one)

(Circle one)

Y/N

Y/N

Y/N

11 12

13

14

15

Record hours: 60-day inspection log is present and properly filled out. Tank tested within past year and passed test in accordance with NACE Code of Practice Standard. Pipe tested within past year and passed test in accordance with NACE Code of Practice Standard. Records available for last two Impressed Current

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

16

Cathodic Protection tests. Cathodic protection system failure was

inspected/repaired within 60-days of test. Impressed Current Cathodic Protection passes

inspection.

Questions 8&9 and 12–16 are (P) or (PC)

Form Number: MDE/WAS/COM.055 Date: April 3, 2007 TTY Users: 800-735-2258

Facility I.D.

_________________

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