Indiana Farmstead Assessment for Drinking Water Protection Fuel Handling & Storage

Use this survey to assess the risk to groundwater quality posed by your fuel handling and storage practices. Circle the answer that best describes your fuel storage. At the end of each section sum the numbers that correspond to each answer for the section total. When you have completed the survey sum the section totals for the risk assessment score. Refer to for more information on fuel storage.

For each question, a (1) represents a higher risk to drinking water than a (3).

Fuel Handling

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

	concrete or asphalt pad (3)
	clay soil or gravel     (2)
	sandy soil              (1)

2. Is someone present during equipment fueling to prevent overfilling?

	present entire time     (3) 
	present most of time    (2) 
	start filling, leave and 
	  return after set time (1)

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

	automatic shut-off      (3)
	overfill alarm          (2) 
	no protective device    (1)

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

	no signs                (3) 
	fuel smell, spill or 
	    drip spot on ground (2)
	visible fuel leak from 
	    pump or nozzle      (1)

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

	Yes (1)
	No  (3)


		Fuel Handling  section total  _______________

Storage Tank Design & Installation

6. Is your fuel storage tank located:

	100 feet or more from a water well or surface water?
		Yes (3)
		No  (1) 
	downslope from a well or surface water?
		Yes (3)
		No  (1)

7. Describe the soil drainage at your fuel storage area.

	well drained 	 	(3) 
	moderately well drained (2) 
	poorly drained, sometimes standing water (1)

8. How was your fuel tank installed?

	by a certified tank contractor		    (3) 
	according to manufacturer's recommendations (2)
	no special precautions		 	    (1)

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

	Yes (3)
	No  (2)

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

	synthetic (fiberglass, etc.) 		      (3) 
	steel with cathodic protection from corrosion (3)
	painted or coated steel 		      (2)
	bare steel 				      (1)

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

	cathodically protected  (3)
	galvanized / coated     (2) 
	bare steel, unprotected (1)

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

	Yes (3)
	No  (1)


		Storage Tank Design & Installation section total_________

Storage Tank Maintenance & Security

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

	at least once a month (3)
	occasionally 	      (2)
	never		      (1)

14. How often do you perform a test of fuel tank tightness?

	once a year	       	       (3) 
	more than a year between tests (2)
	never 			       (1)

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

	Yes (1)
	No  (3)

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

	Yes (3)
	No  (1)

		Storage Tank Maintenance & Security section total _________

Other Management

Circle Yes or No

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

		Yes 	No 

Are fuel pumps or tanks labeled as to the type of fuel dispensed? 

		Yes 	No 

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

		Yes     No

Total number of Yes answers: ______ 

Total number of No answers: ______ 

If you had more Yes than No answers, the section total is 3; otherwise
the total is 2.

		Other Management section total ___________


Add the following totals:

Fuel Handling section total ____ x 4 			  = _________ 

Storage Tank Design & Installation section total ____ x 3 = _________ 

Storage Tank Maintenance & Security section total ____ x 2= _________ 

Other Management section total 				  = _________


		Survery 4 Total Score = _________________


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	Low	       	    Moderate			High
     159 - 109		    110 - 70		       71 - 52
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click here for Fact Sheet 4

Fuel Handling & Storage Fact Sheet