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WACTON <br /> ENGINEERING, INC. � <br /> Xjaxl-6-5 ItR Tcl' <br /> Date: <br /> Owner: <br /> Facility: <br /> OPW Overfill Model Number: <br /> Part 1 -Proper Height Setting Calculation <br /> Tank 1 Tank 2 Tank 3 Tank 4 <br /> Maximum Tank Volume Per: A Gattons 113a <br /> Max shut off requirement for flapper is 95% B 95% <br /> Multiply Max tank volume by 95% C Gallons 096'0 <br /> Use tank chart or ATG to determine height of n Inches v Soy 4 <br /> calculated volume <br /> Measure top of fill riser threads,or face seal E Inches <br /> adapter <br /> Tank diameter(From Tank Chart) F Inches <br /> Upper Tube in Tank(G)F-D=G G Inches <br /> Subtract 2"from upper tube in tank G-2"=K K Inches `�Y5/ <br /> Calculated minimum upper tube length(1) I Inches <br /> K+E=I <br /> Actual measured upper tube length(Without J Inches <br /> fill adapter) <br /> Part 2-Device Certification Criteria Evaluation <br /> Does the overfill prevention device meet the 95% <br /> requirement? <br /> Is the actual measured upper tube length 6.5 inches or <br /> more than the fill riser?(J must be 6.5"or more than E) <br /> Does the overfill prevention device function as required70f — <br /> Device <br /> (Inspect the device for damage,contamination,freedommovement,weakenin due to wear and corrosion)Certification PASS/FAIL <br /> Technician certifies that the device is operationally compliant. <br /> Signature of Technician: Date: <br />