HomeMy WebLinkAbout OPI 10-08-19 Fed ExCERS = California Environmental Reporting System, ID = Identification, UST = Underground storage tank, ICC = International Code Council, A/V = Audible and visual
UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1)
Type of Action Installation Inspection Repair Inspection 36 Month Inspection
I. FACILITY INFORMATION
CERS ID
Date of Overfill Prevention Equipment Inspection
Business Name (Same as Facility Name or DBA-Doing Business As.)
Business Site Address
City
ZIP Code
II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION
Name of UST Service Technician Performing the Inspection (Print as shown on the ICC Certification.)
Phone # ( ) - Ext. Contractor/Tank Tester License #
ICC Certification #
ICC Certification Expiration Date Overfill Prevention Equipment Inspection Training and Certifications (List applicable certifications.) III. OVERFILL PREVENTION EQUIPMENT INSPECTION INFORMATION
Inspection Method Used: Manufacturer Guidelines (Specify)
Industry Code or Engineering Standard (Specify)
Engineered Method (Specify)
Attach the inspection procedures and all documentation required to determine the results. # of Attached Pages:
Tank ID: (By tank number, stored product, etc.)
What is the tank inside diameter? (Inches)
Is the fill piping secondarily contained? Yes No Yes No Yes No Yes No
Is the vent piping secondarily contained? Yes No Yes No Yes No Yes No
Overfill Prevention Equipment Manufacturer(s)
What is the overfill prevention equipment response when activated?
(Check all that apply.)
Shuts Off Flow Shuts Off Flow Shuts Off Flow Shuts Off Flow
Restricts Flow Restricts Flow Restricts Flow Restricts Flow
A/V Alarm A/V Alarm A/V Alarm A/V Alarm
Are flow restrictors installed on vent piping? Yes No Yes No Yes No Yes No
At what level in the tank is the overfill prevention set to activate? (Inches from bottom of tank.)
What is the percent capacity of the tank at which the overfill prevention equipment activates?
Is the overfill prevention in proper operating condition to respond when the substance reaches the appropriate level?
Yes Yes Yes Yes
No (Specify in section V.) No (Specify in section V.) No (Specify in section V.) No (Specify in section V.)
IV. SUMMARY OF INSPECTION RESULTS
Overfill Prevention Inspection Results Pass Fail Pass Fail Pass Fail Pass Fail
V. COMMENTS
All items marked “Fail” must be explained in this section. Any additional comments may also be provided here.
VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION
I hereby certify that the overfill prevention equipment was inspected in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.2 and all the information contained herein is accurate.
UST Service Technician Signature
If the facility has more components than this form accommodates, additional copies of this page may be attached.
Check (A) on tank chart
Flapper Depth
(D)
In-Tank Activation Height
H - D = (A)
Product
Tank Diameter
(T)
Riser Height
(R)
Tank 3Tank 2Tank 1
Overfill Prevention Calculations Form
Tank 4
Measurements
Calculation
Total Height
T + R = (H)
* This form and the tank charts must be submitted with test results form
Tank full volume
(V)
Find percent
(A) x 100 ÷ (V)
Modern Welding Company
Subsidiaries Nationwide
www.modweldco.com
modern@modweldco.com
Tank Calibration Chart
Cylindrical Tank / Horizontal Orientation
Striker Plate: 0 inches
Diameter: 109.5 inchesLength: 294.5 inches
Total Volume: 12,006 gallons
Depth
(inches)
Volume
(gallons)
0.000 0
0.500 6
1.000 18
1.500 33
2.000 50
2.500 70
3.000 92
3.500 115
4.000 141
4.500 168
5.000 196
5.500 226
6.000 257
6.500 289
7.000 323
7.500 358
8.000 394
8.500 430
9.000 468
9.500 507
10.000 547
10.500 587
11.000 629
11.500 671
12.000 715
12.500 759
13.000 803
13.500 849
14.000 895
14.500 942
15.000 990
15.500 1,038
16.000 1,087
16.500 1,137
17.000 1,187
17.500 1,238
Depth
(inches)
Volume
(gallons)
18.000 1,289
18.500 1,341
19.000 1,394
19.500 1,447
20.000 1,501
20.500 1,555
21.000 1,610
21.500 1,665
22.000 1,721
22.500 1,777
23.000 1,833
23.500 1,890
24.000 1,948
24.500 2,006
25.000 2,064
25.500 2,123
26.000 2,182
26.500 2,242
27.000 2,302
27.500 2,362
28.000 2,423
28.500 2,484
29.000 2,546
29.500 2,607
30.000 2,669
30.500 2,732
31.000 2,795
31.500 2,858
32.000 2,921
32.500 2,985
33.000 3,048
33.500 3,113
34.000 3,177
34.500 3,242
35.000 3,307
35.500 3,372
Depth
(inches)
Volume
(gallons)
36.000 3,437
36.500 3,503
37.000 3,569
37.500 3,635
38.000 3,702
38.500 3,768
39.000 3,835
39.500 3,902
40.000 3,969
40.500 4,036
41.000 4,104
41.500 4,171
42.000 4,239
42.500 4,307
43.000 4,375
43.500 4,444
44.000 4,512
44.500 4,580
45.000 4,649
45.500 4,718
46.000 4,787
46.500 4,856
47.000 4,925
47.500 4,994
48.000 5,063
48.500 5,132
49.000 5,202
49.500 5,271
50.000 5,341
50.500 5,410
51.000 5,480
51.500 5,549
52.000 5,619
52.500 5,689
53.000 5,759
53.500 5,828
Depth
(inches)
Volume
(gallons)
54.000 5,898
54.500 5,968
55.000 6,038
55.500 6,108
56.000 6,177
56.500 6,247
57.000 6,317
57.500 6,387
58.000 6,456
58.500 6,526
59.000 6,596
59.500 6,665
60.000 6,735
60.500 6,804
61.000 6,874
61.500 6,943
62.000 7,012
62.500 7,081
63.000 7,150
63.500 7,219
64.000 7,288
64.500 7,357
65.000 7,425
65.500 7,494
66.000 7,562
66.500 7,631
67.000 7,699
67.500 7,767
68.000 7,834
68.500 7,902
69.000 7,970
69.500 8,037
70.000 8,104
70.500 8,171
71.000 8,238
71.500 8,304
Depth
(inches)
Volume
(gallons)
72.000 8,371
72.500 8,437
73.000 8,503
73.500 8,568
74.000 8,634
74.500 8,699
75.000 8,764
75.500 8,829
76.000 8,893
76.500 8,957
77.000 9,021
77.500 9,085
78.000 9,148
78.500 9,211
79.000 9,274
79.500 9,336
80.000 9,399
80.500 9,460
81.000 9,522
81.500 9,583
82.000 9,644
82.500 9,704
83.000 9,764
83.500 9,823
84.000 9,883
84.500 9,941
85.000 10,000
85.500 10,058
86.000 10,115
86.500 10,172
87.000 10,229
87.500 10,285
88.000 10,341
88.500 10,396
89.000 10,451
89.500 10,505
Depth
(inches)
Volume
(gallons)
90.000 10,559
90.500 10,612
91.000 10,664
91.500 10,717
92.000 10,768
92.500 10,819
93.000 10,869
93.500 10,919
94.000 10,968
94.500 11,016
95.000 11,064
95.500 11,111
96.000 11,157
96.500 11,202
97.000 11,247
97.500 11,291
98.000 11,334
98.500 11,377
99.000 11,418
99.500 11,459
100.00011,499
100.50011,538
101.00011,575
101.50011,612
102.00011,648
102.50011,683
103.00011,716
103.50011,749
104.00011,780
104.50011,810
105.00011,838
105.50011,865
106.00011,890
106.50011,914
107.00011,936
107.50011,956
Depth
(inches)
Volume
(gallons)
108.00011,973
108.50011,988
109.00012,000
109.50012,006
Page 1 of 1
This volumetric tank chart is supplied to you for informational purposes only. These capacity calculations are based on
theoretical volumes not actual volumes, and do not reflect atmospheric conditions or thermal expansion/contraction due to
temperature changes. If internal accessories such as pumps are present, displacement of these accessories must be
considered. Therefore, neither Modern Welding Company nor its officers, directors, employee affiliates or subsidiaries shall be
liable for the use of this information covered within. This information is advisory only and the use of the material and methods issolely at the risk of the user.