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HomeMy WebLinkAboutOVERFILL 2020 Appendix IX Underground Storage Tank Overfill Prevention Equipment Inspection Report Form CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council, OPE = Overfill Prevention Equipment Page 1 of 2 TYPE OF ACTION ☐ Installation ☐ Repair X 36 Month 1. FACILITY INFORMATION CERS ID 10125802 Inspection Date 12/15/2020 Facility Name Samco (White Lane) Facility Address 3300 WHITE LN City Bakersfield ZIP Code 93309 2. SERVICE TECHNICIAN INFORMATION Company Performing the Inspection Advanced Compliance Phone 6617064321 Mailing Address 4007 Brae Burn Dr Bakersfield Ca 93306 Service Technician Performing Inspection Bradley Hinsley Contractor/Tank Tester License Number 971259 ICC Number 8373948 Expiration Date 8/10/2021 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date ICC Service Techican 8/10/2021 Veeder-root 2/4/2022 4. INSPECTION PROCEDURES INFORMATION Inspection Procedures Used Components Inspected Veeder-Root Overfill Veeder-Root Overfill Audible/Visible alarm 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION I hereby certify that the OPE was inspected in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.2; that required supporting documentation is attached; and all information contained herein is accurate. I understand that test procedures shall be made available upon request by the governing authority. Service Technician Signature Date 12/15/2020 Total # of Pages 6. OVERFILL PREVENTION EQUIPMENT DETAILS Underground Storage Tank Overfill Prevention Equipment Inspection Report Additional copies of this page may be attached. Attach tank chart(s), measurements, calculations, and In-Tank Setup report(s) Page 2 of 2 Tank ID (one OPE per column) 87 91 Are both vent and tank riser piping secondarily contained? ☐ Yes X No ☐ Yes X No ☐ Yes ☐ No ☐ Yes ☐ No OPE Model VR A/V VR A/V What is the OPE response when activated? (Check all that apply.) ☐ Shut off Flow ☐Restricts Flow X Audible Alarm X Visual Alarm ☐ Shut off Flow ☐Restricts Flow X Audible Alarm X Visual Alarm ☐ Shut off Flow ☐Restricts Flow ☐ Audible Alarm ☐ Visual Alarm ☐ Shut off Flow ☐Restricts Flow ☐ Audible Alarm ☐ Visual Alarm Are flow restrictors installed on vent piping that may interfere with the OPE operation? ☐ Yes* X No ☐ Yes* X No ☐ Yes* ☐ No ☐ Yes* ☐ No At what level in the tank is the OPE set to activate? (Inches from bottom of tank) 81 81 What is the percent capacity of the tank at which the OPE activates? 90 90 Is the OPE in proper operating condition to respond when the stored substance reaches the designated regulatory level? X Yes ☐ No X Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No 7. SUMMARY OF TESTING RESULTS OPE Inspection Results X Pass ☐ Fail X Pass ☐ Fail ☐ Pass ☐ Fail ☐ Pass ☐ Fail 1 8. COMMENTS Describe all results marked “Fail” and each proposed remedy. * Mark here if: ☐ Flow restrictors interfere with overfill prevention and equipment repairs required.