HomeMy WebLinkAbout10-11-19 KCSS - Overfill 90477CERS = 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: 96 inchesLength: 384 inches
Total Volume: 12,032 gallons
Depth
(inches)
Volume
(gallons)
0.000 0
0.500 8
1.000 22
1.500 40
2.000 61
2.500 85
3.000 112
3.500 141
4.000 172
4.500 204
5.000 239
5.500 275
6.000 313
6.500 352
7.000 393
7.500 435
8.000 479
8.500 524
9.000 570
9.500 617
10.000 665
10.500 714
11.000 764
11.500 816
12.000 868
12.500 921
13.000 975
13.500 1,031
14.000 1,086
14.500 1,143
15.000 1,201
15.500 1,259
16.000 1,318
16.500 1,378
17.000 1,439
17.500 1,500
Depth
(inches)
Volume
(gallons)
18.000 1,562
18.500 1,624
19.000 1,688
19.500 1,752
20.000 1,816
20.500 1,881
21.000 1,947
21.500 2,013
22.000 2,080
22.500 2,147
23.000 2,215
23.500 2,283
24.000 2,352
24.500 2,422
25.000 2,491
25.500 2,562
26.000 2,632
26.500 2,704
27.000 2,775
27.500 2,847
28.000 2,919
28.500 2,992
29.000 3,065
29.500 3,139
30.000 3,212
30.500 3,287
31.000 3,361
31.500 3,436
32.000 3,511
32.500 3,586
33.000 3,662
33.500 3,738
34.000 3,814
34.500 3,891
35.000 3,967
35.500 4,044
Depth
(inches)
Volume
(gallons)
36.000 4,121
36.500 4,199
37.000 4,276
37.500 4,354
38.000 4,432
38.500 4,510
39.000 4,588
39.500 4,667
40.000 4,745
40.500 4,824
41.000 4,903
41.500 4,982
42.000 5,061
42.500 5,140
43.000 5,220
43.500 5,299
44.000 5,379
44.500 5,458
45.000 5,538
45.500 5,617
46.000 5,697
46.500 5,777
47.000 5,857
47.500 5,936
48.000 6,016
48.500 6,096
49.000 6,176
49.500 6,256
50.000 6,335
50.500 6,415
51.000 6,495
51.500 6,574
52.000 6,654
52.500 6,733
53.000 6,813
53.500 6,892
Depth
(inches)
Volume
(gallons)
54.000 6,971
54.500 7,050
55.000 7,129
55.500 7,208
56.000 7,287
56.500 7,366
57.000 7,444
57.500 7,522
58.000 7,600
58.500 7,678
59.000 7,756
59.500 7,834
60.000 7,911
60.500 7,988
61.000 8,065
61.500 8,142
62.000 8,218
62.500 8,294
63.000 8,370
63.500 8,446
64.000 8,521
64.500 8,597
65.000 8,671
65.500 8,746
66.000 8,820
66.500 8,894
67.000 8,967
67.500 9,040
68.000 9,113
68.500 9,185
69.000 9,257
69.500 9,329
70.000 9,400
70.500 9,471
71.000 9,541
71.500 9,611
Depth
(inches)
Volume
(gallons)
72.000 9,680
72.500 9,749
73.000 9,817
73.500 9,885
74.000 9,952
74.500 10,019
75.000 10,086
75.500 10,151
76.000 10,216
76.500 10,281
77.000 10,345
77.500 10,408
78.000 10,471
78.500 10,533
79.000 10,594
79.500 10,654
80.000 10,714
80.500 10,773
81.000 10,832
81.500 10,889
82.000 10,946
82.500 11,002
83.000 11,057
83.500 11,111
84.000 11,164
84.500 11,217
85.000 11,268
85.500 11,318
86.000 11,368
86.500 11,416
87.000 11,463
87.500 11,509
88.000 11,553
88.500 11,597
89.000 11,639
89.500 11,680
Depth
(inches)
Volume
(gallons)
90.000 11,719
90.500 11,757
91.000 11,793
91.500 11,828
92.000 11,861
92.500 11,892
93.000 11,921
93.500 11,947
94.000 11,971
94.500 11,993
95.000 12,011
95.500 12,025
96.000 12,032
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.