HomeMy WebLinkAbout2022 Overfill RepairAppendix 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
10134247 3/15/2022
Jaco #7785 Fastrip #32
3701 Ming Avenue Bakersfield 93309
Nwestco LLC (800) 339-9930
2209 Zeus Court, Bakersfield, CA 93308
Aaron Perrigo
1073967
8485827 8/17/2022
FFS 1010993708 7/10/2022
PEI-1200 Overfill Equipment
3/15/2022
Total # of Pages
5
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
Defender
79.75”
93.34%
No issues with flapper valve.
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3URGXFW 87
134.25”
50.00”
79.75”
10904
11682
93.34%
11682
10904
778