Da Form 5457 - Potable Water Container Inspection
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1
2REPORT DATE
POTABLE WATER CONTAINER INSPECTION
For use of this form see TB MED 577; the proponent of this form is the Office of The Surgeon General.
TO
FROM
INSPECTION RATING
SERIAL NUMBER
MAP COORDINATE LOCATION
OWNING UNIT
MAINTENANCE NCO
UNIT REPRESENTATIVE
INSPECTION UNIT
DATE/TIME GROUP
INSPECTED BY
SECTION I. WATER TRAILER INSPECTION CRITERIA
YES
NO
1.
CONTAINER EXTERIOR
a.
Marked "POTABLE WATER ONLY"
b.
Clean/Good Repair
a.
Rubber Gasket Intact
2.
MANHOLE COVERS
b.
Locking Mechanism Functions
c.
No Rust/Insulation Intact
d.
Pressure Relief Valve Operates
a.
3.
DISPENSING SPIGOTS
All Spigots Function
b.
"T" Handle Operates Easily
c.
Protective Box Intact
d.
Locking Devices Function
4.
a.
Plug Installed Hand-Tight
DRAIN
b.
Cracks Do Not Expose Fiberglass
c.
Plug/Hole Threads Undamaged
d.
Threads Not Rusted
CONTAINER INTERIOR:
5.
a.
Clean/Good Repair
STAINLESS STEEL AND
b.
No Rust
ALUMINUM
c.
Not Painted/Coated
d.
No Cracks/Dents Exposing
Polyurethane
CONTAINER INTERIOR:
6.
a.
Clean/Good Repair
FIBERGLASS
b.
Cracks/Chips Less Than 10%
c.
Fiberglass Exposed
d.
Paint Surface Not Flaking
SECTION II. WATER TANK TRUCK INSPECTION CRITERIA
1.
CONTAINER EXTERIOR
a.
Marked "POTABLE WATER ONLY"
b.
Clean/Good Repair
2.
MANHOLE COVERS AND FILLING
a.
Rubber Gaskets Intact
PORTS
b.
Locking Mechanisms Function
c.
No Rust/Insulation Intact
3.
DISPENSING VALVES
a.
Valves Operate Easily
b.
Hose Coupling Threads Undamaged
c.
Dust Caps Attached to Valve Ports
4.
TANK INTERIOR
a.
Clean/Good Repair
b.
No Rust
c.
Steel/Aluminum Not Painted
DA FORM 5457, NOV 2005
APD LC v1.01ES
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