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HomeMy WebLinkAboutOverfill 2021 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 ☐ 36 Month 1. FACILITY INFORMATION CERS ID Inspection Date Facility Name Facility Address City ZIP Code 2. SERVICE TECHNICIAN INFORMATION Company Performing the Inspection Phone Mailing Address Service Technician Performing Inspection Contractor/Tank Tester License Number ICC Number Expiration Date 3. TRAINING AND CERTIFICATIONS Manufacturer and Test Equipment Training Certifications Expiration Date 4. INSPECTION PROCEDURES INFORMATION Inspection Procedures Used Components Inspected 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 Total # of Pages 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 6. OVERFILL PREVENTION EQUIPMENT DETAILS Tank ID (one OPE per column) Are both vent and tank riser piping secondarily contained? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No OPE Model What is the OPE response when activated? (Check all that apply.) ☐ 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 ☐ Shut off Flow ☐Restricts Flow ☐ Audible Alarm ☐ Visual Alarm Are flow restrictors installed on vent piping that may interfere with the OPE operation? ☐ Yes* ☐ No ☐ Yes* ☐ No ☐ Yes* ☐ No ☐ Yes* ☐ No At what level in the tank is the OPE set to activate? (Inches from bottom of tank) What is the percent capacity of the tank at which the OPE activates? Is the OPE in proper operating condition to respond when the stored substance reaches the designated regulatory level? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No 7. SUMMARY OF TESTING RESULTS OPE Inspection Results ☐ Pass ☐ Fail ☐ 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. 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: 128 inches Length: 360.5 inches Total Volume: 20,082 gallons Depth (inches) Volume (gallons) 0.000 0 0.500 8 1.000 23 1.500 43 2.000 66 2.500 93 3.000 121 3.500 153 4.000 187 4.500 222 5.000 260 5.500 300 6.000 341 6.500 384 7.000 429 7.500 475 8.000 523 8.500 572 9.000 622 9.500 674 10.000 727 10.500 781 11.000 836 11.500 893 12.000 951 12.500 1,009 13.000 1,069 13.500 1,130 14.000 1,192 14.500 1,255 15.000 1,319 15.500 1,383 16.000 1,449 16.500 1,515 Depth (inches) Volume (gallons) 17.000 1,583 17.500 1,651 18.000 1,720 18.500 1,790 19.000 1,860 19.500 1,932 20.000 2,004 20.500 2,077 21.000 2,151 21.500 2,225 22.000 2,300 22.500 2,376 23.000 2,452 23.500 2,529 24.000 2,607 24.500 2,685 25.000 2,764 25.500 2,843 26.000 2,923 26.500 3,004 27.000 3,085 27.500 3,167 28.000 3,249 28.500 3,332 29.000 3,415 29.500 3,499 30.000 3,584 30.500 3,669 31.000 3,754 31.500 3,840 32.000 3,926 32.500 4,013 33.000 4,100 33.500 4,187 Depth (inches) Volume (gallons) 34.000 4,276 34.500 4,364 35.000 4,453 35.500 4,542 36.000 4,632 36.500 4,722 37.000 4,812 37.500 4,903 38.000 4,994 38.500 5,085 39.000 5,177 39.500 5,269 40.000 5,362 40.500 5,454 41.000 5,547 41.500 5,641 42.000 5,734 42.500 5,828 43.000 5,923 43.500 6,017 44.000 6,112 44.500 6,207 45.000 6,302 45.500 6,398 46.000 6,493 46.500 6,589 47.000 6,685 47.500 6,782 48.000 6,878 48.500 6,975 49.000 7,072 49.500 7,169 50.000 7,267 50.500 7,364 Depth (inches) Volume (gallons) 51.000 7,462 51.500 7,560 52.000 7,658 52.500 7,756 53.000 7,854 53.500 7,953 54.000 8,051 54.500 8,150 55.000 8,249 55.500 8,348 56.000 8,447 56.500 8,546 57.000 8,645 57.500 8,745 58.000 8,844 58.500 8,944 59.000 9,043 59.500 9,143 60.000 9,242 60.500 9,342 61.000 9,442 61.500 9,542 62.000 9,641 62.500 9,741 63.000 9,841 63.500 9,941 64.000 10,041 64.500 10,141 65.000 10,241 65.500 10,341 66.000 10,440 66.500 10,540 67.000 10,640 67.500 10,740 Depth (inches) Volume (gallons) 68.000 10,839 68.500 10,939 69.000 11,039 69.500 11,138 70.000 11,238 70.500 11,337 71.000 11,436 71.500 11,536 72.000 11,635 72.500 11,734 73.000 11,833 73.500 11,932 74.000 12,030 74.500 12,129 75.000 12,227 75.500 12,326 76.000 12,424 76.500 12,522 77.000 12,620 77.500 12,718 78.000 12,815 78.500 12,912 79.000 13,010 79.500 13,107 80.000 13,203 80.500 13,300 81.000 13,396 81.500 13,493 82.000 13,589 82.500 13,684 83.000 13,780 83.500 13,875 84.000 13,970 84.500 14,065 Depth (inches) Volume (gallons) 85.000 14,159 85.500 14,253 86.000 14,347 86.500 14,441 87.000 14,534 87.500 14,627 88.000 14,720 88.500 14,813 89.000 14,905 89.500 14,997 90.000 15,088 90.500 15,179 91.000 15,270 91.500 15,360 92.000 15,450 92.500 15,540 93.000 15,629 93.500 15,718 94.000 15,806 94.500 15,894 95.000 15,982 95.500 16,069 96.000 16,156 96.500 16,242 97.000 16,328 97.500 16,413 98.000 16,498 98.500 16,582 99.000 16,666 99.500 16,750 100.000 16,833 100.500 16,915 101.000 16,997 101.500 17,078 Depth (inches) Volume (gallons) 102.000 17,158 102.500 17,239 103.000 17,318 103.500 17,397 104.000 17,475 104.500 17,553 105.000 17,630 105.500 17,706 106.000 17,782 106.500 17,857 107.000 17,931 107.500 18,005 108.000 18,078 108.500 18,150 109.000 18,221 109.500 18,292 110.000 18,362 110.500 18,431 111.000 18,499 111.500 18,566 112.000 18,633 112.500 18,699 113.000 18,763 113.500 18,827 114.000 18,890 114.500 18,952 115.000 19,013 115.500 19,072 116.000 19,131 116.500 19,189 117.000 19,245 117.500 19,301 118.000 19,355 118.500 19,408 Page 1 of 2 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 is solely at the risk of the user. Depth (inches) Volume (gallons) 119.000 19,460 119.500 19,510 120.000 19,559 120.500 19,607 121.000 19,653 121.500 19,698 122.000 19,741 122.500 19,782 123.000 19,822 123.500 19,859 124.000 19,895 124.500 19,929 125.000 19,960 125.500 19,989 126.000 20,016 126.500 20,039 127.000 20,058 127.500 20,074 128.000 20,082 Cylindrical Tank / Horizontal Orientation Striker Plate: 0 Arraydepth | Diameter: 128 inches | Length: 360.5 inches | Total Volume: 20,082 gallons Modern Welding Company Subsidiaries Nationwide www.modweldco.com modern@modweldco.com Tank Calibration Chart Cylindrical Tank / Horizontal Orientation Striker Plate: 0 inches Diameter: 128.5 inches Length: 214.5 inches Total Volume: 12,042 gallons Depth (inches) Volume (gallons) 0.000 0 0.500 5 1.000 14 1.500 26 2.000 40 2.500 55 3.000 72 3.500 91 4.000 111 4.500 133 5.000 155 5.500 179 6.000 203 6.500 229 7.000 256 7.500 283 8.000 312 8.500 341 9.000 371 9.500 402 10.000 433 10.500 466 11.000 499 11.500 532 12.000 567 12.500 602 13.000 637 13.500 674 14.000 711 14.500 748 15.000 786 15.500 825 16.000 864 16.500 904 Depth (inches) Volume (gallons) 17.000 944 17.500 984 18.000 1,026 18.500 1,067 19.000 1,109 19.500 1,152 20.000 1,195 20.500 1,238 21.000 1,282 21.500 1,327 22.000 1,371 22.500 1,417 23.000 1,462 23.500 1,508 24.000 1,554 24.500 1,601 25.000 1,648 25.500 1,696 26.000 1,743 26.500 1,791 27.000 1,840 27.500 1,889 28.000 1,938 28.500 1,987 29.000 2,037 29.500 2,087 30.000 2,137 30.500 2,188 31.000 2,239 31.500 2,290 32.000 2,341 32.500 2,393 33.000 2,445 33.500 2,497 Depth (inches) Volume (gallons) 34.000 2,550 34.500 2,603 35.000 2,656 35.500 2,709 36.000 2,762 36.500 2,816 37.000 2,870 37.500 2,924 38.000 2,978 38.500 3,033 39.000 3,088 39.500 3,143 40.000 3,198 40.500 3,253 41.000 3,309 41.500 3,364 42.000 3,420 42.500 3,476 43.000 3,533 43.500 3,589 44.000 3,646 44.500 3,702 45.000 3,759 45.500 3,816 46.000 3,873 46.500 3,930 47.000 3,988 47.500 4,045 48.000 4,103 48.500 4,161 49.000 4,219 49.500 4,277 50.000 4,335 50.500 4,393 Depth (inches) Volume (gallons) 51.000 4,451 51.500 4,510 52.000 4,568 52.500 4,627 53.000 4,686 53.500 4,744 54.000 4,803 54.500 4,862 55.000 4,921 55.500 4,980 56.000 5,039 56.500 5,099 57.000 5,158 57.500 5,217 58.000 5,277 58.500 5,336 59.000 5,395 59.500 5,455 60.000 5,514 60.500 5,574 61.000 5,634 61.500 5,693 62.000 5,753 62.500 5,812 63.000 5,872 63.500 5,932 64.000 5,991 64.500 6,051 65.000 6,111 65.500 6,170 66.000 6,230 66.500 6,290 67.000 6,349 67.500 6,409 Depth (inches) Volume (gallons) 68.000 6,468 68.500 6,528 69.000 6,587 69.500 6,647 70.000 6,706 70.500 6,766 71.000 6,825 71.500 6,884 72.000 6,944 72.500 7,003 73.000 7,062 73.500 7,121 74.000 7,180 74.500 7,239 75.000 7,298 75.500 7,357 76.000 7,415 76.500 7,474 77.000 7,532 77.500 7,591 78.000 7,649 78.500 7,707 79.000 7,766 79.500 7,824 80.000 7,881 80.500 7,939 81.000 7,997 81.500 8,054 82.000 8,112 82.500 8,169 83.000 8,226 83.500 8,283 84.000 8,340 84.500 8,397 Depth (inches) Volume (gallons) 85.000 8,453 85.500 8,510 86.000 8,566 86.500 8,622 87.000 8,678 87.500 8,734 88.000 8,789 88.500 8,844 89.000 8,900 89.500 8,955 90.000 9,009 90.500 9,064 91.000 9,118 91.500 9,172 92.000 9,226 92.500 9,280 93.000 9,333 93.500 9,387 94.000 9,440 94.500 9,492 95.000 9,545 95.500 9,597 96.000 9,649 96.500 9,701 97.000 9,752 97.500 9,804 98.000 9,855 98.500 9,905 99.000 9,955 99.500 10,006 100.000 10,055 100.500 10,105 101.000 10,154 101.500 10,203 Depth (inches) Volume (gallons) 102.000 10,251 102.500 10,299 103.000 10,347 103.500 10,394 104.000 10,441 104.500 10,488 105.000 10,534 105.500 10,580 106.000 10,626 106.500 10,671 107.000 10,716 107.500 10,760 108.000 10,804 108.500 10,847 109.000 10,890 109.500 10,933 110.000 10,975 110.500 11,017 111.000 11,058 111.500 11,099 112.000 11,139 112.500 11,178 113.000 11,218 113.500 11,256 114.000 11,294 114.500 11,332 115.000 11,369 115.500 11,405 116.000 11,441 116.500 11,476 117.000 11,510 117.500 11,544 118.000 11,577 118.500 11,609 Page 1 of 2 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 is solely at the risk of the user. Depth (inches) Volume (gallons) 119.000 11,641 119.500 11,671 120.000 11,702 120.500 11,731 121.000 11,759 121.500 11,787 122.000 11,813 122.500 11,839 123.000 11,864 123.500 11,887 124.000 11,910 124.500 11,931 125.000 11,951 125.500 11,970 126.000 11,987 126.500 12,003 127.000 12,017 127.500 12,028 128.000 12,037 128.500 12,042 Cylindrical Tank / Horizontal Orientation Striker Plate: 0 Arraydepth | Diameter: 128.5 inches | Length: 214.5 inches | Total Volume: 12,042 gallons Modern Welding Company Subsidiaries Nationwide www.modweldco.com modern@modweldco.com Tank Calibration Chart Cylindrical Tank / Horizontal Orientation Striker Plate: 0 inches Diameter: 127 inches Length: 146.4 inches Total Volume: 8,028 gallons Depth (inches) Volume (gallons) 0.000 0 0.500 3 1.000 10 1.500 17 2.000 27 2.500 37 3.000 49 3.500 62 4.000 75 4.500 90 5.000 105 5.500 121 6.000 138 6.500 155 7.000 173 7.500 192 8.000 211 8.500 231 9.000 252 9.500 272 10.000 294 10.500 316 11.000 338 11.500 361 12.000 384 12.500 408 13.000 432 13.500 457 14.000 482 14.500 507 15.000 533 15.500 559 16.000 586 16.500 613 Depth (inches) Volume (gallons) 17.000 640 17.500 668 18.000 695 18.500 724 19.000 752 19.500 781 20.000 810 20.500 840 21.000 870 21.500 900 22.000 930 22.500 960 23.000 991 23.500 1,022 24.000 1,054 24.500 1,086 25.000 1,117 25.500 1,150 26.000 1,182 26.500 1,214 27.000 1,247 27.500 1,280 28.000 1,314 28.500 1,347 29.000 1,381 29.500 1,415 30.000 1,449 30.500 1,483 31.000 1,517 31.500 1,552 32.000 1,587 32.500 1,622 33.000 1,657 33.500 1,693 Depth (inches) Volume (gallons) 34.000 1,728 34.500 1,764 35.000 1,800 35.500 1,836 36.000 1,872 36.500 1,908 37.000 1,945 37.500 1,982 38.000 2,018 38.500 2,055 39.000 2,092 39.500 2,129 40.000 2,167 40.500 2,204 41.000 2,242 41.500 2,280 42.000 2,317 42.500 2,355 43.000 2,393 43.500 2,431 44.000 2,470 44.500 2,508 45.000 2,546 45.500 2,585 46.000 2,624 46.500 2,662 47.000 2,701 47.500 2,740 48.000 2,779 48.500 2,818 49.000 2,857 49.500 2,897 50.000 2,936 50.500 2,975 Depth (inches) Volume (gallons) 51.000 3,015 51.500 3,054 52.000 3,094 52.500 3,133 53.000 3,173 53.500 3,213 54.000 3,252 54.500 3,292 55.000 3,332 55.500 3,372 56.000 3,412 56.500 3,452 57.000 3,492 57.500 3,532 58.000 3,572 58.500 3,612 59.000 3,652 59.500 3,692 60.000 3,733 60.500 3,773 61.000 3,813 61.500 3,853 62.000 3,893 62.500 3,934 63.000 3,974 63.500 4,014 64.000 4,054 64.500 4,095 65.000 4,135 65.500 4,175 66.000 4,215 66.500 4,256 67.000 4,296 67.500 4,336 Depth (inches) Volume (gallons) 68.000 4,376 68.500 4,416 69.000 4,456 69.500 4,496 70.000 4,536 70.500 4,576 71.000 4,616 71.500 4,656 72.000 4,696 72.500 4,736 73.000 4,776 73.500 4,816 74.000 4,855 74.500 4,895 75.000 4,935 75.500 4,974 76.000 5,014 76.500 5,053 77.000 5,093 77.500 5,132 78.000 5,171 78.500 5,210 79.000 5,249 79.500 5,288 80.000 5,327 80.500 5,366 81.000 5,405 81.500 5,443 82.000 5,482 82.500 5,520 83.000 5,559 83.500 5,597 84.000 5,635 84.500 5,673 Depth (inches) Volume (gallons) 85.000 5,711 85.500 5,749 86.000 5,787 86.500 5,824 87.000 5,862 87.500 5,899 88.000 5,936 88.500 5,973 89.000 6,010 89.500 6,047 90.000 6,083 90.500 6,120 91.000 6,156 91.500 6,193 92.000 6,229 92.500 6,264 93.000 6,300 93.500 6,336 94.000 6,371 94.500 6,406 95.000 6,441 95.500 6,476 96.000 6,511 96.500 6,545 97.000 6,580 97.500 6,614 98.000 6,648 98.500 6,681 99.000 6,715 99.500 6,748 100.000 6,781 100.500 6,814 101.000 6,846 101.500 6,879 Depth (inches) Volume (gallons) 102.000 6,911 102.500 6,943 103.000 6,974 103.500 7,006 104.000 7,037 104.500 7,068 105.000 7,098 105.500 7,129 106.000 7,159 106.500 7,189 107.000 7,218 107.500 7,247 108.000 7,276 108.500 7,305 109.000 7,333 109.500 7,361 110.000 7,388 110.500 7,416 111.000 7,442 111.500 7,469 112.000 7,495 112.500 7,521 113.000 7,546 113.500 7,571 114.000 7,596 114.500 7,620 115.000 7,644 115.500 7,667 116.000 7,690 116.500 7,713 117.000 7,734 117.500 7,756 118.000 7,777 118.500 7,797 Page 1 of 2 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 is solely at the risk of the user. Depth (inches) Volume (gallons) 119.000 7,817 119.500 7,836 120.000 7,855 120.500 7,873 121.000 7,890 121.500 7,907 122.000 7,923 122.500 7,938 123.000 7,953 123.500 7,967 124.000 7,979 124.500 7,991 125.000 8,002 125.500 8,011 126.000 8,019 126.500 8,025 127.000 8,028 Cylindrical Tank / Horizontal Orientation Striker Plate: 0 Arraydepth | Diameter: 127 inches | Length: 146.4 inches | Total Volume: 8,028 gallons