HomeMy WebLinkAboutOPI 2021Appendix 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
10159161 7/13/2021
Jaco #7781 Fastrip #22 (South)
4013 South H Street Bakersfield 93304
Confidence UST Services, Inc.(800) 339-9930
16250 Meacham Road, Bakersfield, CA 93314
Aaron Perrigo
804904
8485827 8/17/2022
OPW 0148613 8/1/2022
PEI-1200 Overfill Equipment
7/13/2021
Total # of Pages
8
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.
87-1
71SO 71SO 71SO 71SO
96.50”96.75” 98.00” 98.00”
91.96”92.16% 92.92% 93.11%
87-2 91 DSL
21
Appendix B
71SO Overfill Valve in Tank Shut off Level Worksheet
Important: This is meant to be supplemental worksheet and not a substitute to following the installation
manual instructions. All length measurements are in inches. Please contact the Authority Having Jurisdic-
tion (AHJ) and review local, state, and national codes to determine the regulatory requirements governing
shut-off capacity in your region, as well as take into account other considerations such as extreme tank tilt.
Take the following measurements with the valve in-
stalled in the tank:
Distance from the 71SO inlet tube flange to the cast
lug in the 71SO body (see figures), upper tube length.
Note: the Upper Tube Length must be at least 16” to in-
clude the protective bend in the tube.
(D)= ______________________
Distance from the 71SO inlet tube flange to the top and
bottom of lower tube, valve length.
(W)= _____________
(U)= _____________
Distance from the 71SO inlet tube flange to the bottom
of the tank. Note: If a tank bottom protector is present it
may be necessary to add this thickness to dimension
(OPW 6111 & 61TP models add 0.6”)
(B)= _____________
From the tank calibration chart provided by tank manu-
facturer find the dipstick number (Y) which corresponds
to the 100% volume.
(Y)= _____________
1. To determine shut-off percentage:
Subtract upper tube length (D) from distance to tank
bottom (B)
(X) = (B) – (D) - 2” =________________________
Using the tank calibration chart provided by the tank
manufacturer determine the tank capacity at the cal-
culated (X) dimension and the 100% volume (Y) tank
capacity.
(X) tank capacity in gallons = _______________
(Y) tank capacity in gallons = _______________
SO% = (X) capacity / (Y) capacity x100 = __________ Note: The overfill valve must be installed per AHJ require-
ments and all applicable local, state, and national codes. If
the overfill valve is set above the allowable shut-off percent-
age the overfill valve must be removed and replaced. For
reference 40 CFR part 280 Subpart B Section 280.20 overfill
valves should be set to a maximum of 95%.
(B)
To Tank
(D)
Upper
Tube
(W) Valve
Length,
bottom of
cut
(Y)
Tank
Chart
100%
Volume
Dipstick
(U) Valve
Length,
top of cut
3URGXFW 87-1
53.50”
149.00”
147.5”
152.00”
12047
96.50”
11079
12047
91.96%
21
Appendix B
71SO Overfill Valve in Tank Shut off Level Worksheet
Important: This is meant to be supplemental worksheet and not a substitute to following the installation
manual instructions. All length measurements are in inches. Please contact the Authority Having Jurisdic-
tion (AHJ) and review local, state, and national codes to determine the regulatory requirements governing
shut-off capacity in your region, as well as take into account other considerations such as extreme tank tilt.
Take the following measurements with the valve in-
stalled in the tank:
Distance from the 71SO inlet tube flange to the cast
lug in the 71SO body (see figures), upper tube length.
Note: the Upper Tube Length must be at least 16” to in-
clude the protective bend in the tube.
(D)= ______________________
Distance from the 71SO inlet tube flange to the top and
bottom of lower tube, valve length.
(W)= _____________
(U)= _____________
Distance from the 71SO inlet tube flange to the bottom
of the tank. Note: If a tank bottom protector is present it
may be necessary to add this thickness to dimension
(OPW 6111 & 61TP models add 0.6”)
(B)= _____________
From the tank calibration chart provided by tank manu-
facturer find the dipstick number (Y) which corresponds
to the 100% volume.
(Y)= _____________
1. To determine shut-off percentage:
Subtract upper tube length (D) from distance to tank
bottom (B)
(X) = (B) – (D) - 2” =________________________
Using the tank calibration chart provided by the tank
manufacturer determine the tank capacity at the cal-
culated (X) dimension and the 100% volume (Y) tank
capacity.
(X) tank capacity in gallons = _______________
(Y) tank capacity in gallons = _______________
SO% = (X) capacity / (Y) capacity x100 = __________ Note: The overfill valve must be installed per AHJ require-
ments and all applicable local, state, and national codes. If
the overfill valve is set above the allowable shut-off percent-
age the overfill valve must be removed and replaced. For
reference 40 CFR part 280 Subpart B Section 280.20 overfill
valves should be set to a maximum of 95%.
(B)
To Tank
(D)
Upper
Tube
(W) Valve
Length,
bottom of
cut
(Y)
Tank
Chart
100%
Volume
Dipstick
(U) Valve
Length,
top of cut
3URGXFW 87-2
52.75”
149.00”
149.00”
151.50”
12047
96.75”
11103
12047
92.16%
21
Appendix B
71SO Overfill Valve in Tank Shut off Level Worksheet
Important: This is meant to be supplemental worksheet and not a substitute to following the installation
manual instructions. All length measurements are in inches. Please contact the Authority Having Jurisdic-
tion (AHJ) and review local, state, and national codes to determine the regulatory requirements governing
shut-off capacity in your region, as well as take into account other considerations such as extreme tank tilt.
Take the following measurements with the valve in-
stalled in the tank:
Distance from the 71SO inlet tube flange to the cast
lug in the 71SO body (see figures), upper tube length.
Note: the Upper Tube Length must be at least 16” to in-
clude the protective bend in the tube.
(D)= ______________________
Distance from the 71SO inlet tube flange to the top and
bottom of lower tube, valve length.
(W)= _____________
(U)= _____________
Distance from the 71SO inlet tube flange to the bottom
of the tank. Note: If a tank bottom protector is present it
may be necessary to add this thickness to dimension
(OPW 6111 & 61TP models add 0.6”)
(B)= _____________
From the tank calibration chart provided by tank manu-
facturer find the dipstick number (Y) which corresponds
to the 100% volume.
(Y)= _____________
1. To determine shut-off percentage:
Subtract upper tube length (D) from distance to tank
bottom (B)
(X) = (B) – (D) - 2” =________________________
Using the tank calibration chart provided by the tank
manufacturer determine the tank capacity at the cal-
culated (X) dimension and the 100% volume (Y) tank
capacity.
(X) tank capacity in gallons = _______________
(Y) tank capacity in gallons = _______________
SO% = (X) capacity / (Y) capacity x100 = __________ Note: The overfill valve must be installed per AHJ require-
ments and all applicable local, state, and national codes. If
the overfill valve is set above the allowable shut-off percent-
age the overfill valve must be removed and replaced. For
reference 40 CFR part 280 Subpart B Section 280.20 overfill
valves should be set to a maximum of 95%.
(B)
To Tank
(D)
Upper
Tube
(W) Valve
Length,
bottom of
cut
(Y)
Tank
Chart
100%
Volume
Dipstick
(U) Valve
Length,
top of cut
3URGXFW 91
49.75”
147.50”
147.50”
150.00”
12047
98.00”
11195
12047
92.92%
21
Appendix B
71SO Overfill Valve in Tank Shut off Level Worksheet
Important: This is meant to be supplemental worksheet and not a substitute to following the installation
manual instructions. All length measurements are in inches. Please contact the Authority Having Jurisdic-
tion (AHJ) and review local, state, and national codes to determine the regulatory requirements governing
shut-off capacity in your region, as well as take into account other considerations such as extreme tank tilt.
Take the following measurements with the valve in-
stalled in the tank:
Distance from the 71SO inlet tube flange to the cast
lug in the 71SO body (see figures), upper tube length.
Note: the Upper Tube Length must be at least 16” to in-
clude the protective bend in the tube.
(D)= ______________________
Distance from the 71SO inlet tube flange to the top and
bottom of lower tube, valve length.
(W)= _____________
(U)= _____________
Distance from the 71SO inlet tube flange to the bottom
of the tank. Note: If a tank bottom protector is present it
may be necessary to add this thickness to dimension
(OPW 6111 & 61TP models add 0.6”)
(B)= _____________
From the tank calibration chart provided by tank manu-
facturer find the dipstick number (Y) which corresponds
to the 100% volume.
(Y)= _____________
1. To determine shut-off percentage:
Subtract upper tube length (D) from distance to tank
bottom (B)
(X) = (B) – (D) - 2” =________________________
Using the tank calibration chart provided by the tank
manufacturer determine the tank capacity at the cal-
culated (X) dimension and the 100% volume (Y) tank
capacity.
(X) tank capacity in gallons = _______________
(Y) tank capacity in gallons = _______________
SO% = (X) capacity / (Y) capacity x100 = __________ Note: The overfill valve must be installed per AHJ require-
ments and all applicable local, state, and national codes. If
the overfill valve is set above the allowable shut-off percent-
age the overfill valve must be removed and replaced. For
reference 40 CFR part 280 Subpart B Section 280.20 overfill
valves should be set to a maximum of 95%.
(B)
To Tank
(D)
Upper
Tube
(W) Valve
Length,
bottom of
cut
(Y)
Tank
Chart
100%
Volume
Dipstick
(U) Valve
Length,
top of cut
3URGXFW DSL
48.00”
145.50”
145.50”
148.00”
12047
98.00”
11217
12047
93.11%