HomeMy WebLinkAboutOPI 2023Appendix 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
✔
3/3/23
ARCO
2800 PANAMA LN BAKERSFIELD 93313
BSSR,INC 661-588-2777
6630 ROSEDALE HWY SUITE B. BAKERSFIELD,CA. 93308
NATHAN HOLMAN
672812
8111067 8/23/24
OPW 10/20/24
MANUFACTUER SPEC 87-1-2-3, 91
3/3/23
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.
87-1 87-2 87-3 91
✔✔✔✔
71SO 71SO 71SO 71SO
✔✔✔✔
✔✔✔✔
78 78 78 78
92.9%92.9%92.9%92.9%
✔✔✔✔
✔✔✔✔
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
50
130
89 3/4
78
8998
9684
92.9
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
89 3/4
78
8998
9684
92.9
51
131
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
89 3/4
78
8998
9684
92.9
51
131
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
89 3/4
78
8998
9684
92.9
48
128
7901 XERXES AVENUE SOUTH
MINNEAPOLIS, MN 55431-1288
www.xerxescorp.com
952-887-1890
CAUTION: Do not use the Calibration Chart without reviewing Xerxes® Installation Manual and Operating Guidelines, and Xerxes® applicable
Limited Warranty, copies of which are in the literature packet delivered to the site, or available at www.xerxescorp.com.
Dipstick Calibration Chart for 10,000 Gallon - 8' Diameter DWT-II Tank
GALLONSDIPSTICKREADING DIPSTICKREADING GALLONS GALLONSDIPSTICKREADING DIPSTICKREADING GALLONS GALLONSDIPSTICKREADING DIPSTICKREADING GALLONS
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2125
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2156
2171
2187
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56-5/8"
56-3/4"
56-7/8"
57"
57-1/8"
57-1/4"
57-3/8"
57-1/2"
57-5/8"
57-3/4"
57-7/8"
58"
58-1/8"
58-1/4"
58-3/8"
58-1/2"
58-5/8"
58-3/4"
58-7/8"
59"
59-1/8"
59-1/4"
59-3/8"
59-1/2"
59-5/8"
59-3/4"
59-7/8"
60"
60-1/8"
60-1/4"
60-3/8"
60-1/2"
60-5/8"
60-3/4"
60-7/8"
61"
61-1/8"
61-1/4"
61-3/8"
61-1/2"
61-5/8"
61-3/4"
61-7/8"
62"
62-1/8"
62-1/4"
62-3/8"
62-1/2"
62-5/8"
62-3/4"
62-7/8"
63"
63-1/8"
63-1/4"
63-3/8"
63-1/2"
63-5/8"
63-3/4"
63-7/8"
64"
64-1/8"
64-1/4"
64-3/8"
64-1/2"
64-5/8"
64-3/4"
64-7/8"
65"
65-1/8"
65-1/4"
65-3/8"
65-1/2"
65-5/8"
65-3/4"
65-7/8"
66"
66-1/8"
66-1/4"
66-3/8"
66-1/2"
66-5/8"
66-3/4"
66-7/8"
67"
67-1/8"
67-1/4"
67-3/8"
67-1/2"
67-5/8"
67-3/4"
67-7/8"
68"
68-1/8"
68-1/4"
68-3/8"
68-1/2"
68-5/8"
68-3/4"
68-7/8"
69"
69-1/8"
69-1/4"
69-3/8"
69-1/2"
69-5/8"
69-3/4"
69-7/8"
70"
70-1/8"
70-1/4"
70-3/8"
70-1/2"
70-5/8"
70-3/4"
70-7/8"
71"
71-1/8"
71-1/4"
71-3/8"
71-1/2"
71-5/8"
71-3/4"
71-7/8"
72"
72-1/8"
72-1/4"
72-3/8"
72-1/2"
72-5/8"
72-3/4"
72-7/8"
73"
73-1/8"
73-1/4"
73-3/8"
73-1/2"
73-5/8"
73-3/4"
73-7/8"
74"
74-1/8"
74-1/4"
74-3/8"
74-1/2"
74-5/8"
74-3/4"
74-7/8"
75"
75-1/8"
75-1/4"
75-3/8"
75-1/2"
75-5/8"
75-3/4"
75-7/8"
76"
43-5/8"
43-3/4"
43-7/8"
44"
44-1/8"
44-1/4"
44-3/8"
44-1/2"
44-5/8"
44-3/4"
44-7/8"
45"
45-1/8"
45-1/4"
45-3/8"
45-1/2"
45-5/8"
45-3/4"
45-7/8"
46"
46-1/8"
46-1/4"
46-3/8"
46-1/2"
46-5/8"
46-3/4"
46-7/8"
47"
47-1/8"
47-1/4"
47-3/8"
47-1/2"
47-5/8"
47-3/4"
47-7/8"
48"
48-1/8"
48-1/4"
48-3/8"
48-1/2"
48-5/8"
48-3/4"
48-7/8"
49"
49-1/8"
49-1/4"
49-3/8"
49-1/2"
49-5/8"
49-3/4"
49-7/8"
50"
50-1/8"
50-1/4"
50-3/8"
50-1/2"
50-5/8"
50-3/4"
50-7/8"
51"
51-1/8"
51-1/4"
51-3/8"
51-1/2"
51-5/8"
76-1/8"
76-1/4"
76-3/8"
76-1/2"
76-5/8"
76-3/4"
76-7/8"
77"
77-1/8"77-1/4"77-3/8"77-1/2"77-5/8"77-3/4"77-7/8"78"78-1/8"78-1/4"78-3/8"78-1/2"78-5/8"78-3/4"78-7/8"79"79-1/8"79-1/4"79-3/8"79-1/2"79-5/8"79-3/4"79-7/8"80"
80-1/8"
80-1/4"
80-3/8"
80-1/2"
80-5/8"
80-3/4"
80-7/8"
81"
81-1/8"
81-1/4"
81-3/8"
81-1/2"
81-5/8"
81-3/4"
81-7/8"
82"
82-1/8"
82-1/4"
82-3/8"
82-1/2"
82-5/8"
82-3/4"
82-7/8"
83"
83-1/8"
83-1/4"
83-3/8"
83-1/2"
83-5/8"
83-3/4"
83-7/8"
84"
84-1/8"
84-1/4"
84-3/8"
84-1/2"
84-5/8"
84-3/4"
84-7/8"
85"
85-1/8"
85-1/4"
85-3/8"
85-1/2"
85-5/8"
85-3/4"
85-7/8"
86"
86-1/8"
86-1/4"
86-3/8"
86-1/2"
86-5/8"
86-3/4"
86-7/8"
87"
87-1/8"
87-1/4"
87-3/8"
87-1/2"
87-5/8"
87-3/4"
87-7/8"
88"
88-1/8"
88-1/4"
88-3/8"
88-1/2"
88-5/8"
88-3/4"
88-7/8"
89"
89-1/8"
89-1/4"
89-3/8"
89-1/2"
89-5/8"
89-3/4"
GALLONS DIPSTICKREADING GALLONS GALLONSDIPSTICKREADING DIPSTICKREADING GALLONS GALLONSDIPSTICKREADING DIPSTICKREADING GALLONS
x810D2.1 - 07/05fbf
DIPSTICKREADING
XerXes CorporaTIon Dipstick Calibration Chart for 10,000 Gallon - 8' Diameter DWT-II Tank
47284746
4763
4781
4798
4816
4833
4851
4869
4886
4904
4921
4936
4956
4974
4991
5009
5026
5044
5061
5079
5096
5114
5131
5149
5166
5184
5201
5219
5236
5254
5271
5289
5306
5324
5341
5359
5376
5394
5411
5429
5446
5464
5481
5498
5516
5533
5551
5568
5585
56035620563856555672569057075724574257595776579458115828
5845
58635880589759145932594959665983600060186035605260696086
6103
6120
6138
6155
6172
6189
6206
6223
6240
6257
6274
6291
6308
6325
6342
6359
6375
6392
6409
6426
6443
6460
6477
6493
6510
6527
6544
6561
6577
6594
6611
6627
6644
6661
6677
6694
6710
6727
6744
6760
6777
6793
6810
6826
6842
6859
6875
6892
6908
6924
6941
69576973
6990
7006
7022
7038
7054
7071
7087
7103
7119
7135
7151
7167
7183
7199
7215
7231
7247
7263
7278
7294
7310
7326
7342
7357
7373
7389
7404
7420
7436
7451
7467
7482
7498
7513
7529
7544
7559
7575
7590
7605
7621
7636
7651
7666
7682
7697
7712
7727
77427757777277877802781778317846786178767891790579207934
7949
9467
9475
9482
9489
94979504951195189524953195389544955195579563956995759581
9587
9593
9598
9603
9609
9614
9619
9624
9629
9633
9638
9642
9646
9650
9654
9658
9662
9665
9668
9671
9674
9676
9679
9681
9682
9684
9684
882788398850886288748885
8897
8908
8920
8931
8942
8954
8965
8976
8987
8998
9009
9020
9031
9042
9052
9063
9074
9084
909591059116912691369146915791679177918791979206
9216
9226
9235
9245
9254
9264
9273
9282
9292
9301
9310
9319
9328
9337
9345
9354
9363
9371
9380
9388
9396
9405
9413
9421
9429
9437
9444
9452
9460
7964
7978
7993
8007
8022
8036
8050
8065
8079
8093
8107
8122
8136
8150
8164
8178
8192
8206
8220
8234
8247
8261
8275
8289
8302
8316
8330
8343
8357
8370
8384
8397
8411
8424
8437
8450
8464
8477
8490
8503
8516
8529
8542
8555
8568
8580
8593
8606
8619
86318644865686698681869487068718873187438755876787798791
8803
8815
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