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i � <br /> v5 2 <br /> ALTON <br /> JAR <br /> Overfill Prevention Inspection - OPW 61 71 eriespD'171 a <br /> Date: / <br /> Owner: <br /> Facility : 00 J . Z ;; ��/ <br /> Overfill Model Number: .,iLmL 0 _ f rC� C) 6;le i--jaIy4 xz <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 % r �! <br /> Multiply Max tank volume by 95% C Gallons / C-� <br /> Use tank chart or ATG to determine height of <br /> calculated volume D taches <br /> ' <br /> 4 <br /> Measure top of fill riser threads, or face seal <br /> . adapter E Inches <br /> Tank diameter (From Tank Chart) 7F Inches aei <br /> Upper Tube in Tank (G) F-D = G G Inches <br /> Subtract 2" from upper tube in tan K K Inches a ? <br /> Calculated minimum upper tube length (I) <br /> K+E=I 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 Overfill Certification PASS / FAIL <br /> Drop Tube Testing PASS / FAIL <br /> Technician certifies that the device is operationally compliant. <br /> Signature of Technician : Date: <br /> Technician 's Name : <br />