HomeMy WebLinkAbout10-08-19 Arco White Lane - Overfill 91012CERS = 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: 92 inchesLength: 404 inches
Total Volume: 11,626 gallons
Depth
(inches)
Volume
(gallons)
0.000 0
0.500 8
1.000 22
1.500 41
2.000 63
2.500 88
3.000 115
3.500 145
4.000 177
4.500 210
5.000 246
5.500 283
6.000 322
6.500 363
7.000 405
7.500 448
8.000 493
8.500 539
9.000 586
9.500 634
10.000 684
10.500 734
11.000 786
11.500 839
12.000 892
12.500 947
13.000 1,003
13.500 1,059
14.000 1,117
14.500 1,175
15.000 1,234
15.500 1,294
16.000 1,354
16.500 1,416
17.000 1,478
17.500 1,541
Depth
(inches)
Volume
(gallons)
18.000 1,604
18.500 1,668
19.000 1,733
19.500 1,798
20.000 1,865
20.500 1,931
21.000 1,998
21.500 2,066
22.000 2,135
22.500 2,204
23.000 2,273
23.500 2,343
24.000 2,413
24.500 2,484
25.000 2,555
25.500 2,627
26.000 2,700
26.500 2,772
27.000 2,845
27.500 2,919
28.000 2,993
28.500 3,067
29.000 3,141
29.500 3,216
30.000 3,292
30.500 3,367
31.000 3,443
31.500 3,519
32.000 3,596
32.500 3,673
33.000 3,750
33.500 3,827
34.000 3,904
34.500 3,982
35.000 4,060
35.500 4,138
Depth
(inches)
Volume
(gallons)
36.000 4,217
36.500 4,295
37.000 4,374
37.500 4,453
38.000 4,532
38.500 4,612
39.000 4,691
39.500 4,771
40.000 4,850
40.500 4,930
41.000 5,010
41.500 5,090
42.000 5,170
42.500 5,250
43.000 5,331
43.500 5,411
44.000 5,491
44.500 5,572
45.000 5,652
45.500 5,733
46.000 5,813
46.500 5,894
47.000 5,974
47.500 6,054
48.000 6,135
48.500 6,215
49.000 6,295
49.500 6,376
50.000 6,456
50.500 6,536
51.000 6,616
51.500 6,696
52.000 6,776
52.500 6,855
53.000 6,935
53.500 7,014
Depth
(inches)
Volume
(gallons)
54.000 7,094
54.500 7,173
55.000 7,252
55.500 7,331
56.000 7,409
56.500 7,488
57.000 7,566
57.500 7,644
58.000 7,722
58.500 7,799
59.000 7,877
59.500 7,954
60.000 8,030
60.500 8,107
61.000 8,183
61.500 8,259
62.000 8,335
62.500 8,410
63.000 8,485
63.500 8,559
64.000 8,634
64.500 8,707
65.000 8,781
65.500 8,854
66.000 8,927
66.500 8,999
67.000 9,071
67.500 9,142
68.000 9,213
68.500 9,283
69.000 9,353
69.500 9,423
70.000 9,492
70.500 9,560
71.000 9,628
71.500 9,695
Depth
(inches)
Volume
(gallons)
72.000 9,762
72.500 9,828
73.000 9,893
73.500 9,958
74.000 10,022
74.500 10,086
75.000 10,148
75.500 10,210
76.000 10,272
76.500 10,332
77.000 10,392
77.500 10,451
78.000 10,510
78.500 10,567
79.000 10,623
79.500 10,679
80.000 10,734
80.500 10,787
81.000 10,840
81.500 10,892
82.000 10,942
82.500 10,992
83.000 11,040
83.500 11,087
84.000 11,133
84.500 11,178
85.000 11,221
85.500 11,263
86.000 11,304
86.500 11,343
87.000 11,380
87.500 11,416
88.000 11,450
88.500 11,481
89.000 11,511
89.500 11,538
Depth
(inches)
Volume
(gallons)
90.000 11,563
90.500 11,585
91.000 11,604
91.500 11,618
92.000 11,626
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.