HomeMy WebLinkAbout2024 OPI 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
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
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.
Check (A) on tank chart
Flapper Depth
(D)
In-Tank Activation Height
H - D = (A)
Product
Tank Diameter
(T)
Riser Height
(R)
Tank 3Tank 2Tank 1
Overfill Prevention Calculations Form
Tank 4
Measurements
Calculation
Total Height
T + R = (H)
* This form and the tank charts must be submitted with test results form
Tank full volume
(V)
Find percent
(A) x 100 ÷ (V)