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WALTON � NMI, <br /> MOR NEEL31NGo NN Cw <br /> Date , <br /> Owner, -'� o <br /> 0' <br /> Facility : ° <br /> T- - <br /> OPW Overfill Model Number: <br /> Part 1 - Proper Height Setting Calculation <br /> Tank 1 Tank 2 Tank 3 Tank 4 <br /> Maximum Tank Volume Per; A Gallons <br /> Max shut off requirement for flapper is 95% n 953'0 q� <br /> Multiply Max tank volume by 95% C Gallons a 3 � &LI� LT <br /> Use tank chart or ATG to determine height of �✓'7 ,* <br /> calculated volume D Inches c . oor3 ZS �&jrj;b <br /> Measure top of fill riser threads , or face seal E Inches <br /> adapter <br /> Tank diameter (From Tank Chart) F Inches ez <br /> Upper Tube in Tank (G) F-D = G G Inches e ��• % rr 76 " <br /> Subtract 2" from upper tube in tank G-2 K K Inches ! X3 <br /> 3 <br /> Calculated minimum upper tube length (I) <br /> K+E�.I Inches <br /> Actual measured upper tube length (Without <br /> . fill adapter) (J) J Inches <br /> Part 2 - Device Certification Criteria Evaluation <br /> Does the overfill prevention device meet the 95 % <br /> requirement? <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) <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 Certification PASS / FAM <br /> Technician certifies that the device is operationally compliant.- NII ROM ' <br /> Signature of Technician : Date .. <br />