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Appendix IX <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />6. OVERFILL PREVENTION EQUIPMENT DETAILS <br />Tank ID one OPE percolumn <br />T-1/ Diesel <br />Are both vent and tank riser piping <br />o Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />secondarily contained? <br />❑ No <br />❑ No <br />❑ No <br />❑ No <br />OPE Model <br />Veeder <br />What is the OPE response when activated? <br />❑ Shuts off <br />❑ Shuts off <br />❑ Shuts off <br />❑ Shuts off <br />(Check all that apply.) <br />Flow <br />Flow <br />Flow <br />Flow <br />❑ Restricts <br />❑ Restricts <br />❑ Restricts <br />❑ Restricts <br />Flow <br />Flow <br />Flow <br />Flow <br />o Audible <br />❑ Audible <br />❑ Audible <br />❑ Audible <br />Alarm <br />Alarm <br />Alarm <br />Alarm <br />o Visual <br />❑ Visual <br />❑ Visual <br />❑ Visual <br />Alarm <br />Alarm <br />Alarm <br />Alarm <br />Are flow restrictors installed on vent piping <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />that may interfere with the OPE operation? <br />o No <br />❑ No <br />❑ No <br />❑ No <br />At what level in the tank is the OPE set to <br />77.5 <br />activate? (Inches from bottom of tank) <br />What is the percent capacity of the tank at <br />90 <br />which the OPE activates? <br />Is the OPE in proper operating condition to <br />N Yes <br />❑ Yes <br />❑ Yes <br />❑ Yes <br />respond when the stored substance reaches <br />❑ No <br />❑ No <br />❑ No <br />❑ No <br />the designated regulatory level? <br />7. SUMMARY OF TESTING RESULTS <br />❑x Pass <br />❑ Pass <br />❑ Pass <br />❑ Pass <br />OPE Inspection Results <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />❑ Fail <br />8. COMMENTS <br />❑ Yes <br />El Yes <br />❑ Yes <br />❑ Yes <br />Are Flow Restrictors Installed? <br />❑x No <br />❑ No <br />❑ No <br />❑ No <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 />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Page 2 of 8 <br />