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Home My WebLink AboutOPI 2023CERS = California Environmental Reporting System, ID = Identification, UST = Underground storage tank, ICC = International Code Council, A/V = Audible and visual UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1) Type of Action Installation Inspection Repair Inspection 36 Month Inspection I. FACILITY INFORMATION CERS ID 10023307 Date of Overfill Prevention Equipment Inspection 7/5/2023 Business Name (Same as Facility Name or DBA-Doing Business As.) Minit Stop Business Site Address 2900 Union Ave. City Bakersfield ZIP Code 93305 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Inspection (Print as shown on the ICC Certification.) Bruce W. Hinsley Phone # (661) 706 - 4321 Ext. Contractor/Tank Tester License # 971259 ICC Certification # 8032698 ICC Certification Expiration Date 6/25/2025 Overfill Prevention Equipment Inspection Training and Certifications (List applicable certifications.) 1193980 III. OVERFILL PREVENTION EQUIPMENT INSPECTION INFORMATION Inspection Method Used: Manufacturer Guidelines (Specify) OPW Overfill Prevention Industry Code or Engineering Standard (Specify) Engineered Method (Specify) Attach the inspection procedures and all documentation required to determine the results. # of Attached Pages: Tank ID: (By tank number, stored product, etc.) 87 91 What is the tank inside diameter? (Inches) 111 111 0 Is the fill piping secondarily contained? Yes No Yes No Yes No Yes No Is the vent piping secondarily contained? Yes No Yes No Yes No Yes No Overfill Prevention Equipment Manufacturer(s) OPW OPW What is the overfill prevention equipment response when activated? (Check all that apply.) Shuts Off Flow Shuts Off Flow Shuts Off Flow Shuts Off Flow Restricts Flow Restricts Flow Restricts Flow Restricts Flow A/V Alarm A/V Alarm A/V Alarm A/V Alarm Are flow restrictors installed on vent piping? Yes No Yes No Yes No Yes No At what level in the tank is the overfill prevention set to activate? (Inches from bottom of tank.) 95 97 What is the percent capacity of the tank at which the overfill prevention equipment activates? 91 93 Is the overfill prevention in proper operating condition to respond when the substance reaches the appropriate level? Yes Yes Yes Yes No (Specify in section V.) No (Specify in section V.) No (Specify in section V.) No (Specify in section V.) IV. SUMMARY OF INSPECTION RESULTS Overfill Prevention Inspection Results Pass Fail Pass Fail Pass Fail Pass Fail V. COMMENTS All items marked “Fail” must be explained in this section. Any additional comments may also be provided here. VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION I hereby certify that the overfill prevention equipment was inspected in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.2 and all the information contained herein is accurate. UST Service Technician Signature If the facility has more components than this form accommodates, additional copies of this page may be attached. 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 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