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Home My WebLink AboutOPI 2023 REPAIRAppendix IXUnderground 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 ✔ 2/24/23 ARCO 3125 CALIFORNIA AVE BAKERSFIELD BSSR INC 661-588-2777 6630 ROSEDALE HWY NATHAN HOLMAN 672812 8111067 8/23/24 OPW 10/20/24 MANUFACTUER GUIDELINES 87 10K, 91 2/24/23 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 answers marked “No” or “Fail” and proposed remedy. List all monitoring equipment either replaced or repaired. * Mark here if: Flow restrictors interfere with overfill prevention and equipment repairs required. 87 10K 91 ✔✔ 71SO 71SO ✔✔ ✔✔ 104.5 106 94.8 95 ✔✔ ✔✔ REPLACEMENT OF 87 10K AND 91 OVERFILL VALVES DUE TO FAILURE 21 Appendix B 71SO Overfill Valve in Tank Initial 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 59.75 166.25 117-75 104.5 9837 10369 94.8 21 Appendix B 71SO Overfill Valve in Tank Initial 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 63 171 117.75 106 11334 11849 95