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Underground Storage Tank <br /> Overfill Prevention Equipment InS ection Report Form <br /> 6. OVERFILL PREVENTION EQUIPMENT DETAILS <br /> Tank ID (One OPE per column) 87 91 DSL <br /> Are both vent and tank riser piping E Yes E Yes E Yes ❑ Yes <br /> secondarily contained? ❑ No ❑ No ❑ No ❑ No <br /> OPE Model OPW OPW OPW <br /> Tank Manufacturer Xerxes Xerxes Xerxes <br /> E Shuts off E Shuts off E Shuts off ❑ Shuts off <br /> Flow Flow Flow Flow <br /> What is the OPE response when ❑ Restricts ❑ Restricts ❑ Restricts ❑ Restricts <br /> activated? Flow Flow Flow Flow <br /> (Check a//that apply.) ❑ Audible ❑ Audible ❑ Audible ❑ Audible <br /> Alarm Alarm Alarm Alarm <br /> ❑Visual [-]Visual ❑Visual ❑Visual <br /> Alarm Alarm Alarm Alarm <br /> Are flow restrictors installed on vent <br /> piping that may interfere with the OPE ❑ Yes F1 Yes E] Yes E] Yes <br /> operation? E No E No E No E] No <br /> At what level in the tank is the OPE set to 1061/4 1053/4 105 <br /> activate? (Inches from bottom of tank) <br /> What is the percent capacity of the tank in o 0 0 <br /> which the OPE activates? 95/0 95/0 95/o <br /> Is the OPE in proper operating condition <br /> to respond when the stored substance ® Yes E Yes E Yes E] Yes <br /> reaches the designated regulatory level? E] No ❑ No El No El No <br /> 7. SUMMARY OF TESTING RESULTS <br /> OPE Inspection Results E Pass E Pass E Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> 8. COMMENTS <br /> Page 2 of 2 <br />