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Underground Storage Tank Overfill Prevention Equipment Testing Report Form 6. OVERFILL PREVENTION EQUIPMENT DETAILS Test Method Developed by ® Manufacturer ❑ Industry Standard ❑ Professional Engineer ❑ Check this box if Appendix 7.1 continuation page is attached. Tank ID (one OPE per column) T1-Re ular T2-Diesel T3-Diesel T4-Premium Tank Manufacturer Xerxes Xerxes Xerxes Xerxes Tank Capacity (Gallons) 25,000 25,000 16,000 16,000 Tank Inside Diameter (Inches) 119.375 119.375 119.375 119.375 Are both vent and tank riser piping ® Yes ® Yes ® Yes ® Yes secondarily contained? ❑ No ❑ No ❑ No ❑ No OPE Manufacturer/ Model OPW 71 SO OPW 71 SO OPW 71 SO OPW 71 SO What is the OPE response when activated? ® Shut off ® Shut off ® Shut off ® Shut off (Check all that apply.) ❑ Restrict ❑ Restrict ❑ Restrict El Restrict ❑Audible ❑ Audible ❑ Audible ❑ Audible ❑ Visual ❑ Visual ❑ Visual ❑ Visual Are flow restrictors installed on vent piping ❑ Yes* ❑ Yes* ❑ Yes* ❑ Yes* that may interfere with the OPE operation? ® No ® No ® No ® No For audible/visual overfill alarms, are they ® Yes ® Yes ® Yes ® Yes clearly audible/visible at the tank fill point? ❑ No ❑ No ❑ No ❑ No At what level in the tank does the OPE activate? (Inches from bottom of tank) 107.125" 107.125" 106.25" 104.375" What is the percent capacity of the tank at which the OPE activates? 94% 94% 94% 93% Is the OPE in proper operating condition to ® Yes ® Yes ® Yes ® Yes respond when the stored substance reaches the designated regulatory level? ❑ No ❑ No ❑ No El No 7. SUMMARY OF TEST RESULTS OPE Test Results ® Pass ® Pass ® Pass ® Pass ❑ Fail ❑ Fail ❑ Fail ❑ Fail 8. COMMENTS * ❑ Check this box if flow restrictors interfere with overfill prevention and repairs are required. All tests marked "Fail' and any repairs made during the test must be described in Section 8. Attach tank chart(s), measurements, calculations, and In-Tank Setup report(s) Page 2 of 2