HomeMy WebLinkAboutOPI 2020Appendix 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 XXXX36 Month
1. FACILITY INFORMATION
CERS ID
10022869
Inspection Date
12/16/2020
Facility Name
Circle K
Facility Address
5634 Stine Rd.
City
Bakersfield
ZIP Code
93313
2. SERVICE TECHNICIAN INFORMATION
Company Performing the Inspection
B&T Service Station Contractors
Phone
805-929-8944
Mailing Address
630 S. Frontage Rd. Nipomo, CA 93444
Service Technician Performing Inspection
Michael A. Molacek
Contractor/Tank Tester License Number
902034
ICC Number
9175943
Expiration Date
11/15/2021
3.TRAINING AND CERTIFICATIONS
Manufacturer and Test Equipment Training Certifications Expiration Date
OPW EVR UST Certification #0178497 06/24/2021
FFS EVR Phase 1 Systems 11/11/2021
4.INSPECTIONPROCEDURES INFORMATION
InspectionProcedures Used Components Inspected
Industry Standard 87 91 drop tubes
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
12/16/2020
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?
XXXX Yes
☐☐☐☐ No
XXXX Yes
☐☐☐☐ No
☐☐☐☐ Yes
☐☐☐☐ No
☐☐☐☐ Yes
☐☐☐☐ No
OPE Model 71-SO 71-SO
What is the OPE response when activated?
(Check all that apply.)
XXXX Shut off
Flow
☐☐☐☐Restricts
Flow
☐☐☐☐ Audible
Alarm
☐☐☐☐ Visual
Alarm
XXXX Shut off
Flow
☐☐☐☐Restricts
Flow
☐☐☐☐ Audible
Alarm
☐☐☐☐ 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*
XXXX No
☐☐☐☐ Yes*
XXXX No
☐☐☐☐ Yes*
☐☐☐☐ No
☐☐☐☐ Yes*
☐☐☐☐ No
At what level in the tank is the OPE set to
activate? (Inches from bottom of tank)
90 92
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?
XXXX Yes
☐☐☐☐ No
XXXX Yes
☐☐☐☐ No
☐☐☐☐ Yes
☐☐☐☐ No
☐☐☐☐ Yes
☐☐☐☐ No
7. SUMMARY OF TESTING RESULTS
OPE Inspection Results XXXXPass
☐☐☐☐Fail
XXXXPass
☐☐☐☐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.