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DEP Form # 62-761.900(4)_______________
Florida Department of Environmental Environmental Protection Twin Towers Office Bldg. •2600 Blair Stone Road •Tallahassee, Florida 32399-2400
Form Title: Alternative Requirement Requirement or Procedure Form_______ Effective Date: July 13, 1998___________ _
API 653 Tank Inspection Summary Form Please print or type, fill out all boxes that apply, and attach to API 653 Report Gerneral Information Information Facility Name:
Settlement within Tolerance? Bottom Differential Edge Bulges/Ridges
Shell?
Yes Yes Yes Yes
Yes No
No No No No
REPAIR SUMMARY: (Include description, date completed, and date of post-repair inspection) Foundation: _______________________________________________________________________________________________________ ___ _______________________________________________________________________________________________________ ___