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WALTON <br /> ENGINEERING, INC. <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 /> Maximum Tank Volume Per: A Gallons <br /> Max shut off requirement for flapper is 95% B 95% <br /> Multiply Max tank volume by 95% C Gallons a00 <br /> Use tank chart or ATG to determine height of $033 , <br /> calculated volume D Inches <br /> Measure top of fill riser threads,or face seal E Inches <br /> adapter <br /> Tank diameter(From Tank Chart) F Inches g'q <br /> Upper Tube in Tank(G)F-D=G G Inches <br /> Subtract 2"from upper tube in tank G-2"=K K Inches y 3 <br /> Calculated minimum upper tube length(n <br /> I Inches <br /> K+E=I <br /> Actual measared upper tube length(Without <br /> fill adapter) Inches <br /> Part 2-Device Certification Criteria Evaluation <br /> Does the overfill prevention device meet the 95% <br /> requirement? a <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? NOV 1 3 2018 <br /> (Inspect the device for damage,contamination,freedom of <br /> movement,weakening due to wear and corrosion <br /> L HEALTH <br /> Device Certification PASS/FAIL DEPAR I MENT <br /> Technician certifies that the device is operationally compliant. <br /> Signature of Technician: Date: <br />