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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
10121548
Inspection Date
2/18/2021
Facility Name
ARCO Brundage & H
Facility Address
1701 Brundage Ln
City
Bakersfield
ZIP Code
93304
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
2/18/2021
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) 87N 87M 87S 91
Are both vent and tank riser piping secondarily
contained?
☐ Yes
X No
☐ Yes
X No
☐ Yes
X No
☐ Yes
X No
OPE Model VR A/V VR A/V 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
X Audible
Alarm
X Visual
Alarm
☐ Shut off
Flow
☐Restricts
Flow
X Audible
Alarm
X Visual
Alarm
Are flow restrictors installed on vent piping that
may interfere with the OPE operation?
☐ Yes*
X No
☐ Yes*
X No
☐ Yes*
X No
☐ Yes*
X No
At what level in the tank is the OPE set to
activate? (Inches from bottom of tank)
77.625 77.625 77.625 77.625
What is the percent capacity of the tank at
which the OPE activates?
90 90 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
X Yes
☐ No
X Yes
☐ No
7. SUMMARY OF TESTING RESULTS
OPE Inspection Results X Pass
☐ Fail
X Pass
☐ Fail
X Pass
☐ Fail
X 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.