Retail Facility Checklist General Information
Company Name	Street Address
Primary Contact	Tele:	City	State	Zip
1. *	Dealer’s EPA Establishment number:
2.	Dealer’s unique site/facility number:
3.	The bulk site map will be provided to the inspector
29.	NFPA 704-diamond signs are posted at the site and clearly visible to first responders	Y N
30.	The facility has assessed their security needs (DOT,DHS, ect.) and identified their security requirements	Y N
Facility – General/Required
53.	The facility and surrounding area is neat and free of all debris	Y N
55.	Does the pesticide product storage facility prohibit eating, drinking, or smoking in operational areas?	Y N
57. *	The facility has documentation that cleanout occurred on tank(s) in accordance with the manufacturer’s written cleanout procedures. If “N”, Explain.	Y N NA
62. *	Repackaging Agreements for bulk products being repackaged are on file and available	Y N NA
General Disclaimer: The purpose and intent of this document is to provide minimum standards and guidelines for evaluating the stewardship practices at a retail pesticide product storage facility. This document outlines the “fundamental principles” of product stewardship currently agreed upon by member companies of the American Agronomic Stewardship Alliance and does not provide an inclusive list of all recommended or “best” practices.
This document should not be considered or relied upon as the sole basis or reference for evaluating safety or compliance at any particular facility and does not reflect all of the laws or regulations that local, state, or federal authorities may impose on facilities. The practices listed in this document are designed to complement, and should be implemented in conjunction with, applicable regulatory requirements. Since regulations can change overtime, it is the facility operator’s responsibility to ensure that his or her facility complies with all current and applicable regulations.
This document is not meant to supersede or replace any FIFRA, EPA, DOT, OSHA or individual registrant requirements. Each registrant must provide guidelines and procedures specific to their authorized refill establishments for storage and handling of their bulk products.
American Agronomic Stewardship Alliance assumes no liability to any person or entity for any injury or damage, direct or consequential, which may be incurred from the use application of any of the standards, whether singly or in combination, by any particular facility. American Agronomic Stewardship Alliance assumes no responsibility for the unsuitability of any standards as a result of inconsistency with or changes in the law or otherwise.

Signature____________________________ Print Name _______________________ Date________

(Facility Representative)

Signature____________________________ Print Name _______________________ Date________

(Inspector)

Permission Granted to Take Photos: ____ YES ____NO

* EPA Regulatory Requirement

4-21-21

Tank – General

5.	List the number for each tank present	Tank #	Tank #	Tank #	Tank #	Tank #
6.	List the containment system number from the bulk site map
8.	List the product manufacturer’s name
7.	List the product name as it appears on the label
9.	Tank capacity (in gallons) Note: all tanks must be measured and data recorded on the displacement sheet
10.	Tank configuration and type: H = Horizontal; F = Flat Bottom; C = Cone; D = Dish; O = Other (describe)	H F C D O_________	H F C D O_________	H F C D O_________	H F C D O_________	H F C D O_________
11.	Tank construction material; S304 =Stainless Steel 304; S316= Stainless Steel 316; C =Carbon Steel; P = Polyethylene; A=Aluminum; O=Other (describe)	S304 S316 C P A O_________	S304 S316 C P A O_________	S304 S316 C P A O_________	S304 S316 C P A O_________	S304 S316 C P A O_________
12.	Tank age (Poly only)	___yrs	___yrs	___yrs	___yrs	___yrs
14.	All vents on indoor tanks are vented to the outside?	Y N NA	Y N NA	Y N NA	Y N NA	Y N NA
15.	Pump motor size (Note: If Pneumatic, enter 99; If Gravity Flow or “no pump”, enter 0)	hp	hp	hp	hp	hp
16.	Type of fill port hose connection: C= 2 inch Male Camlock; D =Dry Break; O = Other_______________	C D O	C D O	C D O	C D O	C D O
18.	Identify material of construction for any plumbing from the tank to the first valve: S= Stainless Steel; P= Poly; C= Carbon Steel (black iron) ; PVC= PVC; F= Flexible; NA= Not Plumbed (Note: There could be more than one answer for each tank)	S P C PVC F NA	S P C PVC F NA	S P C PVC F NA	S P C PVC F NA	S P C PVC F NA
21b.	Identify material of construction for any plumbing used from the first valve on: S= Stainless Steel; P= Poly; C= Carbon Steel (black iron); E= EPDM; CL= Cross-Link Poly Lined (AllChem); PVC= PVC; NA= Not Plumbed; O= Other (describe). (Note: There could be more than one answer for each tank)	S P C E CL PVC NA O_________	S P C E CL PVC NA O_________	S P C E CL PVC NA O_________	S P C E CL PVC NA O________	S P C E CL PVC NA O_________
19.	Loading and unloading lines are labeled with the product they are used for?	Y N	Y N	Y N	Y N	Y N
20.	Method(s) used to determine liquid level in the tank: E= Electronic monitor: I= Inventory Records: M= Tank Markings: D= Dipping: L= Level Gauge (Mechanical)	E I M D L	E I M D L	E I M D L	E I M D L	E I M D L
21.	Type of recirculation system: E = Side Eductors (indicate how many); OT = Over-the-Top (describe); NA= No Recirculation	E OT NA _________	E OT NA _________	E OT NA _________	E OT NA _________	E OT NA _________

Tank – General

Tank #	Tank #	Tank #	Tank #	Tank #
21a.	Identify material of construction for plumbing used for recirculation: S = Stainless Steel; P = Poly; C = Carbon Steel (black iron); E = EPDM; CL = Cross Link Poly Lined (All Chem); PVC = PVC; NA = Not Plumbed; O = Other (describe) (Note: There could be more than one answer for each tank).	S P C E CL PVC NA O _________	S P C E CL PVC NA O _________	S P C E CL PVC NA O _________	S P C E CL PVC NA O _________	S P C E CL PVC NA O _________
24.	Tank code: N=None U=UL A=API	N U A	N U A	N U A	N U A	N U A
25.	Are the bulk system electrical components (switches, motors, lights, pump impellers) explosion proof?	Y N	Y N	Y N	Y N	Y N
26.	Desiccant system present and connected?	Y N	Y N	Y N	Y N	Y N
27.	N2 Blanket/Padding present?	Y N	Y N	Y N	Y N	Y N
28.	Can tank temperature be maintained at or above 40 F?	Y N	Y N	Y N	Y N	Y N
Tank - Required
31.*	The tank is labeled which includes a product booklet	Y N	Y N	Y N	Y N	Y N
31a.*	The tank is labeled with the net contents from the last delivery.	Y N	Y N	Y N	Y N	Y N
31b.*	The correct EPA Establishment Number is affixed to the tank.	Y N	Y N	Y N	Y N	Y N
32. *	The tank is free of visible stress cracks, punctures, corrosion, or defects and there are no signs of leakage	Y N	Y N	Y N	Y N	Y N
33. *	The tank’s profile is within the containment wall	Y N	Y N	Y N	Y N	Y N
33b.*	The bulk pesticide tank within the containment unit is anchored or elevated to prevent flotation	Y N	Y N	Y N	Y N	Y N
34. *	Type of vent used: P= Pressure Vacuum Relief Vent; E= Emergency Relief Vent; O= Open Vent; D= Vented to a desiccant; N= Not Vented (Note: There could be more than one answer for each tank)	P E O D N	P E O D N	P E O D N	P E O D N	P E O D N
35.	The dealer verifies that the tank vent has been checked within the last 12 months and is operational	Y N	Y N	Y N	Y N	Y N
36. *	The tank’s inlet/outlet valve is lockable stainless steel. If “N” circle whatever applies: A = Not Stainless Steel; B = Not Lockable; C = Other	Y N A B C	Y N A B C	Y N A B C	Y N A B C	Y N A B C
22. *	Valves on recirculation openings are lockable stainless steel. If “N”, circle whatever applies: A = Not Stainless Steel; B = Not Lockable; C = Other	Y N NA A B C	Y N NA A B C	Y N NA A B C	Y N NA A B C	Y N NA A B C

Tank - Required

Tank #	Tank #	Tank #	Tank #	Tank #
37. *	The tank’s inlet/outlet valve is closed and locked or the facility is locked whenever the site is unattended	Y N	Y N	Y N	Y N	Y N
38b.*	The tank is free of an external sight gauge	Y N	Y N	Y N	Y N	Y N
39.	Pumps, meters, and plumbing are dedicated to each product or formulation: D= Dedicated all the way; C = Common Manifold or Shared Plumbing; NA= No Delivery System; O = Dedicated to the PRC fill site but not to the delivery vehicle.	D C NA O	D C NA O	D C NA O	D C NA O	D C NA O
40. *	If a common manifold or shared plumbing exists, there is a procedure in place to prevent cross-contamination. (Answer “NA” if a dedicated line is used).	Y N NA	Y N NA	Y N NA	Y N NA	Y N NA

Containment - Required
Containment #1	Containment #2	Containment #3	Containment #4
4. 4a.	Measure inside dimensions of the secondary system (unit) and containment pads and record on map. Don’t fill in dimensions on this form. (Note: __ Check here & measure the building if containment is indoors & building is contained) Size of largest pesticide tank in containment ______ (Note: Leave this question blank. The data base company will calculate and answer)	__FTx __FT x __FT	_FTx __FTx__FT	_FTx __Fx__FT	_FTx __FTx__FT
43.	The containment area is: A= Indoors; B= Outdoors and Covered; C= Outdoors and Not Covered	A B C	A B C	A B C	A B C
42. *	The tanks are within rigid liquid-tight secondary containment that has a capacity of at least 100 % (if indoors or outdoors and covered) or 110 % (if outdoors and not covered) of the volume of the largest stationary pesticide container plus the volume displaced by other containers and appurtenances within the containment unit. Some state standards may be more stringent. If so, those requirements would apply. (Note: Leave this question blank. The data base company will calculate and answer for the PCC capacity requirements)	Y N	Y N	Y N	Y N
44. *	All drains, valves, and cracks in the containment are permanently sealed. If ” N” Circle Whatever Applies: A = Crack in Wall C = Drain/Valve Not Sealed B = Crack in Floor	Y N A B C	Y N A B C	Y N A B C	Y N A B C
45. *	All pumps and meters are either within the containment wall or on a liquid-tight surface	Y N	Y N	Y N	Y N
46.	All pipes are within containment or routed over the containment wall	Y N	Y N	Y N	Y N
48. *	If present, sump pumps are manually operated. (Answer “NA” if not present)	Y N NA	Y N NA	Y N NA	Y N NA
47.*	All bulk product “storage” is within containment that is constructed of rigid materials such as poured concrete, steel, or sealed reinforced concrete block, is liquid-tight and compatible with the product(s) being stored and is properly maintained. (If ”N”, explain)	Y N	Y N	Y N	Y N
50. *	All bulk product “dispensing areas” and “transfers” of bulk occur on or within properly maintained rigid containment that is liquid-tight and compatible with the product being dispensed or transferred. (If “N”, explain)	Y N	Y N	Y N	Y N
52. *	The containment for bulk product dispensing or transfers and has a minimum holding capacity of 750 gallons or 100 % of the capacity of the largest pesticide container or bulk product holding equipment used on the containment, whichever is less. (Note: Leave this question blank. The data base company will calculate and answer)	Y N
49. *	All bulk containers are in an area that has a lockable security fence around the facility, the containment unit or the bulk containers are in an enclosed, secured building	Y N

Bulk Tank Facility - General
54.	If secondary containment is not under roof or covered, rainwater is captured from the containment area and collected for use in application blends or mixes	Y N NA
58.	Shower and eyewash equipment are present and operational	Y N

Portable Refillable Containers and Repackaging - Required
59. *	Portable Refillable Containers have a unique identity (dealer #, static serial # or other). Circle” NA” if Service Container	Y N NA
60. *	Portable Refillable Containers containing product have a product label, Directions-for Use booklet, the filler’s EPA Establishment Number and net contents listed. If No, circle the reason: L= label; B= Booklet; E= EPA Est. No.; C= Contents ; NA = PRCs containing product are not present	Y N L B E C NA
61. *	All bulk pesticide product dispensing areas and transfers of pesticide product occurs on or within properly maintained rigid containment that is liquid-tight and compatible with the product being dispensed or transferred. If “N” Explain.	Y N
66. *	The containment for bulk product dispensing or transfers and has a minimum holding capacity of 750 gallons or 100 % of the capacity of the largest pesticide container or bulk product holding equipment used on the containment, whichever is less. (Note: Leave this question blank. The data base company will calculate and answer).	Y N
63. *	Current labels are available at the location for each product being repackaged	Y N
64. *	A written procedure is in place to ensure that Portable Refillable Containers are cleaned according to the manufacturer’s specifications prior to changing product or formulation or if seals are broken.	Y N NA
65a.*	All Portable Refillable Containers are visually inspected before refilling.	Y N
65b.*	All Portable Refillable Containers are equipped with an intact one-way valve and/or a tamper-evident device on each opening that’s not a vent.	Y N
70.*	All Portable Refillable Containers are visually free of chemical residue on the outside	Y N
71.*	All Portable Refillable Containers are regularly inspected and they meet applicable DOT/EPA packaging and/or leak proofness testing requirements.	Y N
Portable Refillable Containers and Repackaging - General
67.	All Portable Refillable Containers (full or empty) are placed or held in an area that would prohibit run-off into streams, ditches or well heads	Y N
68.	All filled Portable Refillable Containers are on or within containment while at the facility	Y N
69.	All Portable Refillable Containers are under cover when empty	Y N
Training - Required
74.	Safety Data Sheets (SDS) are available to employees and customers for chemical products used or sold by the facility	Y N
75.	A written emergency plan for the facility is available and current. This plan includes updated emergency contact and telephone information. Material and equipment are available at the facility to handle emergencies, such as spills, fires, and medical incidents	Y N
76.	Personal protective equipment (PPE) is available to employees and employees are trained in its proper use	Y N
77.	An employee awareness training plan is in place to provide company policy, job-specific operations, evacuation, chemical-specific hazards, cross-contamination hazards and prevention and applicable emergency plan/response procedure information and all training is documented.	Y N
Training - General
78.	One or more employees at the facility receive an average of 20 hours/year of continuing education on product safety, agronomy, emergency response, regulatory compliance, hazard communication and other stewardship related areas	Y N

Packaged Storage - Required
79.	No open drains. All existing floor drains are permanently plugged and sealed	Y N
80.	“No Smoking” signs are posted in the storage facility	Y N
81.	Floors are made of impervious material such as concrete or steel that are structurally sound, smooth finished and caulked on all cracks and saw joints	Y N
82.	Appropriate spill containment and recovery tools and supplies are available in a designated location	Y N
84.	If repair shops with hot work activity are located inside the packaged pesticide storage building, a hot work program is in place	Y N NA
Packaged Storage - General
85.	Pesticide products are stored on the ground floor and not in the basement or on the second story	Y N
86.	The entire packaged pesticide product storage area is contained	Y N
87.	All electrical wiring is in conduit	Y N
88.	Exterior construction is steel, cement, metal clad or other non-combustible material. Wood walls are not used, however if they are used, they are completely covered with metal or other noncombustible materials	Y N
89.	The office walls and ceiling are separated from the warehouse by cement block, concrete, or two layers of 5/8” sheet rock on the interior and external walls and ceiling. Fire rated doors are used for separation of offices from packaged pesticide products storage areas	Y N NA
90.	Audible smoke and/or heat detectors with an electric power source and a back up battery are in place and operational	Y N
91.	Fire alarm(s) are connected to the fire department fire phone or manned security system (if available)	Y N
92.	A fire inspection is conducted annually by the fire department and a written record of such inspection is maintained	Y N
93.	Pesticide products are stored in an area that is separated from animal feed and other foodstuff. Pesticide products are stored at a distance of at least 25’ from such items or are separated by walls from the non-pesticide product storage	Y N NA
94.	Seed is segregated from chemical storage as much as is possible. For example, seed and chemicals are not placed on the same pallet and individual pallets of seed and chemicals do not touch each other.	Y N NA
95.	Two or more sets of personal protective equipment (PPE) such as safety glasses, hard hats, safety shoes, respirators, body coverings (gloves, hoods, boots) are available and readily accessible. One set is stored outside the package storage area and is readily accessible	Y N
96.	Fire extinguishers have a minimum of 10# ABC. Fire extinguishers are strategically located in work areas so that the travel distance to the nearest fire extinguisher does not exceed 75’	Y N
98.	The facility and surrounding area is neat and free of all debris	Y N
99.	Product that is damaged and/or leaking, is contained, placed into over pack containers, properly identified and segregated. Over pack containers are large enough to hold the largest container stored	Y N NA
100.	Empty pallet storage (outdoors) is located at a distance of at least 50’ from the packaged pesticide product storage facility.	Y N NA

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