HomeMy WebLinkAboutOPI 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
10022869
Inspection Date
10/13/2021
Facility Name
Circle k
Facility Address
5634 Stine rd
City
Bakersfield
ZIP Code
2. SERVICE TECHNICIAN INFORMATION
Company Performing the Inspection
B&T SERVICE STATION CONTRACTORS
Phone
(805)929-8944
Mailing Address
630 S. FRONTAGE RD NIPOMO Service Technician Performing Inspection
RICK BINGER Contractor/Tank Tester License Number
902034
ICC Number
8452629
Expiration Date
03/30/2023
3. TRAINING AND CERTIFICATIONS
Manufacturer and Test Equipment Training Certifications Expiration Date
OPW 1192309 07/02/2023
4. INSPECTION PROCEDURES INFORMATION
Inspection Procedures Used Components Inspected
RP1200
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
10/13/2021
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) TANK 1 87 TANK 2 91
Are both vent and tank riser piping
secondarily contained?
☒ Yes
☐ No
☒ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
OPE Model OPW OPW
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)
100 103
What is the percent capacity of the tank at
which the OPE activates?
95% 95%
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.