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WALTON <br /> RGMEERENG, INC. <br /> 119;W5 $�� i�} �.7/� L f✓� 1�s�iK <br /> Overfill Prevention Inspection - OPW 61 and 71 Series Devices <br /> Date: <br /> Owner: <br /> Facility: <br /> OPW Overfill Model Number: <br /> Part 1 - Proper Height Setting Calculation <br /> Tank 1 Tank 2 Tank 3 Tank 4 <br /> Ps <br /> ank Volume Per: A Gallons a/ <br /> f requirement for flapper is 95% B 95% <br /> ax tank volume by 95% C Gallonsart or ATG to determine height ofolume D Inchesof fill riser threads,or face seal < <br /> adapter E Inches " <br /> Tank diameter(From Tank Chart) F Inches <br /> Upper Tube in Tank(G)F-D=G G Inches <br /> 9 <br /> Subtract 2"from upper tube in tank G-2"=K K Inches <br /> Calculated minimum upper tube length(I) <br /> K+E=I I Inches5 <br /> Actual measured upper tube length(Without f J <br /> fill adapter) (J) J Inches <br /> Part 2 - Device Certification Criteria Evaluation <br /> Does the overfill prevention device meet the 95% <br /> requirement? Ye 5 <br /> Is the actual measured upper tube length 6.5 inches or <br /> more than the fill riser?(J must be 6.5"or more than E) Ye 5 <br /> Does the overfill prevention device function as required? <br /> (Inspect the device for damage,contamination,freedom of <br /> movement,weakening due to wear and corrosion) <br /> Device Overfill Certification PASS /FAH- <br /> T- <br /> Drop Tube Testing PASS /FAIL ,v1q <br /> Technician certifies that the device is operationally compliant. <br /> Signature of Technician: Date: <br /> Technician's Name: <br />