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Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />6. OVERFILL PREVENTION EQUIPMENT DETAILS <br />Tank ID (One OPE per column) <br />87 <br />91 <br />DSL <br />Are both vent and tank riser piping <br />® Yes <br />® Yes <br />® Yes <br />❑ Yes <br />secondarily contained? <br />❑ No <br />❑ No <br />❑ No <br />❑ No <br />OPE Model <br />OPW <br />OPW <br />OPW <br />Tank Manufacturer <br />Xerxes <br />Xerxes <br />Xerxes <br />E Shuts off <br />® Shuts off <br />® Shuts off <br />❑ Shuts off <br />Flow <br />Flow <br />Flow <br />Flow <br />What is the OPE response when <br />❑ Restricts <br />❑ Restricts <br />❑ Restricts <br />❑ Restricts <br />activated? <br />Flow <br />Flow <br />Flow <br />Flow <br />(Check all that apply.) <br />❑ Audible <br />❑ Audible <br />❑ Audible <br />❑ Audible <br />Alarm <br />Alarm <br />Alarm <br />Alarm <br />❑Visual <br />❑Visual <br />❑Visual <br />❑Visual <br />Alarm <br />Alarm <br />Alarm <br />Alarm <br />Are flow restrictors installed on vent <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />piping that may interfere with the OPE <br />® No <br />® No <br />® No <br />❑ No <br />operation? <br />At what level in the tank is the OPE set to <br />104" <br />104" <br />103" <br />activate? (Inches from bottom of tank) <br />What is the percent capacity of the tank in <br />94% <br />94% <br />94% <br />which the OPE activates? <br />Is the OPE in proper operating condition <br />® Yes <br />® Yes <br />® Yes <br />❑ Yes <br />to respond when the stored substance <br />❑ No <br />❑ No <br />❑ No <br />❑ No <br />reaches the designated regulatory level? <br />7. SUMMARY OF TESTING RESULTS <br />® Pass <br />® Pass <br />® Pass <br />❑ Pass <br />OPE Inspection Results <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />8. COMMENTS <br />Removed all 3 straight drop tubes and built 3 new drop tubes with flappers to correct tank chart <br />specs. Tested with EMD, all tests passed. <br />Page 2 of 2 <br />