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HomeMy WebLinkAboutOPI 2024Appendix 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 10125616 9-17-24 Xpress Gas (Flower St) 928 Flower St Bakersfield 93305 Nwestco LLC (800) 339-9930 2209 Zeus Court, Bakersfield, CA 93308 Rockland Kirk 1073967 10241356 9-10-26 FFS EVR Phase VR-101 #1016693714 10-16-24 RP 1200 Overfill valves with drop tubes 9-17-24 2 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 Defender 92.25" 95" 90.25% 92.48% 91 ))6'HIHQGHU6HULHV2YHUILOO9DOYH:RUNVKHHW 3URGXFW87 165.75 69 92.25" 10,856 12,028 90.25% 12,028 10,856 1,172                                                 !  "#   $ %  &#''(     )   "&*&+ %  ! , - . )  -% .   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