Dnr Form 542-0068 - Ust Cathodic Protection Inspection Form - Iowa Department Of Natural Resources

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Iowa Department of Natural Resources
Underground Storage Tank Section
th
502 East 9
Street
Des Moines, IA 50319-0034
Iowa Department of Natural Resources
UST Cathodic Protection Inspection Form
Iowa UST Site Registration Number:
Date:
Cathodic protection system is:
Galvanic
Impressed current
Date Installed:
Facility Information
Facility Name:
Address:
City:
ZIP Code:
Cathodic Protection Tester
Tester Name:
Phone Number:
Company Name:
Address:
City:
State:
Zip Code:
Tester Qualifications/Training (567-Chapter 135 IAC, Definitions):
If NACE Certified Provide Certification No.:
Weather Conditions:
Temperature:
Soil/Backfill Conditions (check):
moist
dry
sand
gravel
soil
Minimum Inspection Requirements Checklist
Reviewed the cathodic protection system’s design: location of tanks, lines, anodes, testing locations, and structure to soil
potential readings. For impressed current systems include structure to soil native potential readings and rectifier amp
and voltage settings.
Reviewed record of previous cathodic protection system inspection: tank to soil potential readings, test locations, and
previous inspectors comments and observations. For impressed current systems, review the record for previous rectifier
amp and voltage readings and record current readings.
Provided site diagram with testing locations properly marked.
Tested the system for electrical continuity: tanks, product lines, flex connectors, vent lines, conduit and other tank system
equipment.
Conducted structure to soil potentials on all protected tanks, piping, and flex connectors. A minimum of three per tank
along the center line, at the ends and middle. For each product line, tested above piping at the ends and middle (away
from anode locations). Conducted additional tests on long piping runs.
For impressed current system, conducted structure to soil potentials for rectifier instant off readings. For polarization
readings not meeting the –850 mV requirement, tested for 100 mV polarization decay.
For impressed current system, checked rectifier operation and current to anodes at any junction boxes in system. Asked
owner if any physical changes have been made at site since installation.
Provided written explanation to the site owner on the cathodic protection systems operating status, recommendations,
and any repairs and attached it to this form.
Cathodic Protection System Certification
The cathodic protection system is operating according to its design standards and is providing cathodic protection to the tanks
and product lines:
Yes
No
Signature of Tester
Date
Page 1 of 4
10/2012 cmz
DNR Form 542-0068

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