This Survey assesses the risk to surface and ground water associated with the Fuel Handling and Storage operation on the basis of the answers to the survey questions. Please answer all questions for a fair evaluation.

Fuel Handling:

1. What is the surface type where equipment fueling takes place?

Sandy soil
Concrete or asphalt pad
Clay soil or gravel
Corresponding magnitude of risk

2 Which of these overfill protection devices are connected to your fuel tank?  

Automatic shut off
Overfill alarm
No protective device
Corresponding magnitude of risk

3.Are there signs of fuel spills at the pump or distribution point?  

No signs
No fuel smell, spill or drip spot on ground
Visible fuel leak from pump or nozzle
Corresponding magnitude of risk

4. Is someone present during the equipment fueling to prevent overfilling?  

Present entire time
Present most of the time
Start filling, leave and return after some time
Corresponding magnitude of risk

5. Have you ever had a large fuel spill or leak that you did not clean up?  

Yes
No
Corresponding magnitude of risk

Storage tank design and installation:

6. Is your fuel storage tank located:

a) 100 feet or more from a water well or surface water?

No
Yes
Corresponding magnitude of risk

b) surface water?  

No
Yes
Corresponding magnitude of risk

7. Describe the soil drainage at your fuel storage area

Well drained
Moderately welll drained
Poorly drained, sometimes standing water
Corresponding magnitude of risk

8. How was your fuel tank installed?  

By a certified tank contractor
According to manufacturer's recommendations
No special precautions
Corresponding magnitude of risk

9. Does your fuel tank have a secondary containment strucutre to capture spills or leaks?  

No
Yes
Corresponding magnitude of risk

10. What material is your fuel storage tank made of?

Synthetic(fiberglass)
Steel with cathodic protection from corrosion
Painted or coated steel
Bare steel
Corresponding magnitude of risk

11. What material is piping used in your fuel storage system coated with?  

Cathodically protected
Galvanized/coated
Bare steel/unprotected
Corresponding magnitude of risk

12. Do pipes drain back into the tank after the pump is shut off?  

Yes
No
Corresponding magnitude of risk

Storage tank maintenance and security:

13. How often do you conduct an inventory of fuel tank volume between tank refills?  

At least once a month
Occasionally
Never
Corresponding magnitude of risk

14. How often do you test the fuel tank for airtightness?

Once a year
More than a year between tests
Never
Corresponding magnitude of risk

15. Are there any unused or abandoned fuel storage tanks on the property that have not been properly emptied and closed?  

Yes
No
Corresponding magnitude of risk

16. Is your fuel pump/tank lockable to prevent accidental opening and vandalism?  

Yes
No
Corresponding magnitude of risk

Other Management:

17. Is a no smoking rule enforced at your fuel handling and storage facility?  

Yes
No
Corresponding magnitude of risk

18. Are fuel pumps or tanks labelled as to the type of fuel dispensed?

Yes
No
Corresponding magnitude of risk
;

19. Are you prepared for an emergency in case of a fuel spill or leak?

Yes
No
Corresponding magnitude of risk

Net Survey Score:
Magnitude of risk:

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