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5 P-MT11,I zri DO 1' d�;)Ubaba-sty . 53t�,CA 1114 f zap 1 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Ing ection Report Form <br /> 6. OVERFILL PREVENTION EQUIPMENT DETAILS (Continued) <br /> Tank ID (One OPE per column) <br /> Are both vent and tank riser piping ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> secondarily contained? ❑ No ❑ No ❑ No ❑ No <br /> OPE Model <br /> Tank Manufacturer <br /> E] Shuts off ❑ Shuts off ❑ 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 all that apply.) ❑ Audible ❑ Audible ❑ Audible ❑ Audible <br /> Alarm Alarm Alarm Alarm <br /> ❑Visual ❑Visual E]Visual ❑Visual <br /> Alarm Alarm Alarm Alarm <br /> Are flow restrictors installed on vent ❑ Yes E] Yes ❑ Yes ❑ Yes <br /> piping that may interfere with the OPE NoNo No No <br /> operation? ❑ ❑ ❑ <br /> At what level in the tank is the OPE set to <br /> activate? (Inches from bottom of tank) <br /> What is the percent capacity of the tank in <br /> which the OPE activates? <br /> Is the OPE in proper operating condition ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> to respond when the stored substance 9 ❑ No ❑ No ❑ No ❑ No <br /> reaches the designated regulatory level . <br /> 7. SUMMARY OF TESTING RESULTS <br /> OPE Inspection Results ❑ Pass ❑ Pass ❑ Pass ❑ Pass <br /> Fail Fail Fail Fail <br /> 8. COMMENTS <br /> Page 3of3 <br />