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Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report <br /> 6. OVERFILL PREVENTION EQUIPMENT DETAILS <br /> Tank ID (one OPE per column) 1 Regular 2 Premium 3 Diesel <br /> Are both vent and tank riser piping ❑✓ Yes ❑✓ Yes ❑✓ Yes ❑Yes <br /> secondarily contained? ❑ No ❑No ❑ No ❑ No <br /> OPE Model EBW Auto Limiter2 EBW Auto Limiter2 EBW Defender <br /> What is the OPE response when activated? OShut off OShut off ❑Shut off ❑Shut off <br /> (Check all that apply.) Flow Flow Flow Flow <br /> ❑Restricts ❑Restricts [—]Restricts ❑Restricts <br /> Flow Flow Flow Flow <br /> ❑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 piping ❑Yes* ❑Yes* ❑Yes* ❑Yes* <br /> that may interfere with the OPE operation? ❑✓ No ❑✓ No ✓❑No ❑ No <br /> At what level in the tank is the OPE set to <br /> activate? (Inches from bottom of tank) 103 1/2' 104 1/2" 105 7/8" <br /> What is the percent capacity of the tank at <br /> 93% 94% 94% <br /> which the OPE activates? <br /> Is the OPE in proper operating condition to ✓❑Yes ❑✓ Yes ❑✓ Yes ❑Yes <br /> respond when the stored substance ❑ 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 /> Describe all results marked "Fail"and each proposed remedy. <br /> * Mark here if: <br /> ❑Flow restrictors interfere with overfill prevention and equipment repairs required. <br /> Additional copies of this page may be attached. <br /> Attach tank chart(s), measurements, calculations, and In-Tank Setup report(s) <br /> Page 2 of 2 <br />