Spill Prevention Control & Countermeasures Plan -- Quarterly Spill Source Checklist

Date:    

Your Name:    

Email Address:    

Building and Room #:    

Calendar Year:     2006

Quarter:     1st 2nd 3rd 4th

1. Is there evidence of leakage or spillage around the tanks?
   Yes
   No
2. Is there evidence of settlement, cracking or pitting of the tanks?
   Yes
   No
3. Is there evidence of damage or corrosion to the tank support structures?
   Yes
   No
4. Do the exterior coatings of the tanks require maintenance, cleaning or painting?
   Yes
   No
5. Do the normal and emergency tank vents require cleaning or maintenance?
   Yes
   No Spill Kits
   
6. Were any spill kits used in the last quarter?
   Yes
   No
7. Do any spill kits need replenishment?
   Yes
   No
8. Do replacement spill kits need to be ordered?
   Yes
   No

   Date Ordered:

   Grease Traps
9. Do the underground grease traps require pumping out or cleaning?
   Yes
   No

   If yes, date to be pumped/cleaned:

   Cooking Oil Collection Tanks
10. Is there evidence or leakage or spillage around the tanks?
    Yes
    No

Please provide a full description of all deficiencies and indicate what maintenance or repair needs to be done.

Repairs and Maintenance:   (State expected completion date for each item.)

If work order has been submitted:

Work Order #:    

Date Submitted:    

Updated June 29, 2007 by SAK