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HomeMy WebLinkAboutJim Burke Ford Overfill Results 11-14-2019CERS = 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 10023232 Date of Overfill Prevention Equipment Inspection 11/14/209 Business Name (Same as Facility Name or DBA-Doing Business As.) Jim Burke Ford Business Site Address 2001 Oak St City Bakersfield ZIP Code 93301 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Inspection (Print as shown on the ICC Certification.) Bradley Hinsley Phone # (661) 706 - 4321 Ext. Contractor/Tank Tester License # 971259 ICC Certification # 8373948 ICC Certification Expiration Date 8/10/2021 Overfill Prevention Equipment Inspection Training and Certifications (List applicable certifications.) Veeder-root III. OVERFILL PREVENTION EQUIPMENT INSPECTION INFORMATION Inspection Method Used: Manufacturer Guidelines (Specify) Veeder-root 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.) 87 What is the tank inside diameter? (Inches) 96 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) Veeder-Root 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.) 81 What is the percent capacity of the tank at which the overfill prevention equipment activates? 90 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.