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WO-13153 <br /> UNDERGROUND STORAGE TANK <br /> OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1) <br /> Type of Action ❑Installation Inspection ❑Repair Inspection 0 36 Month Inspection <br /> I. FACILITY INFORMATION <br /> CERS ID Date of Overfill Prevention Equipment Inspection <br /> _ 1/28/2019 <br /> Business Name(Same as Facility Name or DBA-Doing Business As) <br /> Valley Pacific Petroleum <br /> Business Site Address City ZIP Code <br /> 3550 S. 99 Frontage Rd. Stockton 95215 <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Inspection(Print as shown on the ICC Certification.) Phone# <br /> Torstein Armour (707) 437-6668 <br /> Contractor/Tank Tester License# ICC Certification to ICC Certification Expiration Date <br /> 498721 8202044 4/17/2019 <br /> Overfill Prevention Equipment Inspection Training and Certifications(List applicable certiflcations.) - <br /> OPW VR-102 EVR UST Installer Attestation#0162927, exp. 7/11/2020 <br /> Ill. OVERFILL PREVENTION EQUIPMENT INSPECTION INFORMATION <br /> Inspection Method 0 Manufacturer Guidelines(Specify): <br /> Used: OPW Installation & Maintenance <br /> ❑Industry Code or Engineering Standard(Specify): <br /> ❑Engineered Method(Specify): <br /> Attach the inspection procedures and all documentation required to determine the results. #of Attached Pages 13 <br /> TANK ID:(By tank number,stored product,etc.) 3008G Red Diesel <br /> What is the tank inside diameter?(Inches) 95.75" <br /> Is the fill piping secondarily contained? ❑Yes ©No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> Is the vent piping secondarily contained? ❑Yes ❑X No <br /> ❑Yes ❑No ❑Yes ❑No -0 Yes ❑No <br /> Overfill Prevention Equipment Manufacturer(s) OPW <br /> 61SO <br /> What is the overfill prevention equipment response 0 Shuts Off Flow Cl Shuts Off Flow <br /> ❑Shuts Off Flow ❑Shuts Off Flow <br /> when activated? <br /> (Check all that apply.) ❑Restricts Flow ❑Restricts Flow ❑Restricts Flow ❑Restricts Flow <br /> ❑AN Alarm ❑AN Alarm ❑AN Alarm ❑AN Alarm <br /> Are flow restrictors installed on vent piping? ❑Yes 0 No ❑Yes ❑No ❑Yes ❑No ❑Yes ❑No <br /> At what level in the tank is the overfill prevention set <br /> to activate?(Inches from bottom of tank.) 85.625" <br /> What is the percent capacity of the tank at which the <br /> overfill prevention equipment activates? 94.4% <br /> Is the overfill prevention In proper operating condition 0 Yes ❑Yes ❑Yes ❑Yes <br /> to respond when the substance reaches the <br /> appropriate level? ❑No(Specify in V.) ❑No(Specify in V.) ❑No(Specify in V.) ❑No(Specify in V.) <br /> IV. SUMMARY OF INSPECTION RESULTS <br /> Overfill Prevention Inspection Results 0 Pass ❑Fail I ❑Pass ❑Fail I E] 'Pass <br /> ❑Fail ❑Pass ❑Fail <br /> V. COMMENTS <br /> Any items marked Fail"must be explained in this section. Any additional comments may 4=ovi&d here. <br /> E E E D <br /> i <br /> VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION <br /> I hereby certify that the overfill prevention equipment was inspected in accordance vCtt�� �1!�qr�`iii�Cgsle of Regulations,Title 23, <br /> Division 3,Chapter 16,Sec ' 2637.2 and 1 the Information contained herein is a6cul26M5 i IMENTi•'t` HEAL H <br /> UST Servi ehnieiaa ignat re EPARTM EEN1-f.. <br /> 1 the fac y has mor-e—compol-'n1sIthan this form accommodates,additional copies of this page may be attached. <br /> CERS=California Environmental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Council,A/V=Audible and Visual <br />