Laserfiche WebLink
W.O.# NW1-2337835 Cust Ref#: COCO SO-0015267473 <br /> UNDERGROUND STORAGE TANK <br /> OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT F (pop 1 oft) <br /> Type of Action ❑Installation Inspection ❑Repair Enapection Mantra inspection <br /> I. FACILITY INF60 <br /> CERS ID i We ofo verfill Prevention Equipment inspection <br /> Business Name(SWna,N FacW Norm or DBA-Doing Business As) <br /> BuSirmm Sete Address <br /> lGey ca ; c <br /> 11. --- <br /> UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> NaMS01-4SServiceT n P In (FrfM on ! ° I <br /> or I Tank T t t # EG # ICC C Ezow-ation Date <br /> tC ) r <br /> Overfill Prevention t Inspection�ryT ding Brad (t;[ s) <br /> III. OVERFILL PRE1fENTION EQUIPMENT INSPECTION INFORMATION <br /> ( ) <br /> ❑Industry Code or Engheeft Standard(S ): <br /> ❑Engineered M (S ): <br /> ► atr d u uF ro I u . <br /> #ofA PaM <br /> TANK N}:(8y k skved product ) Pr c S <br /> What is the tank inside diameter?(Inches) <br /> is tutpi d? 0 Yes 45tho ❑r 0 Yes ®No 0 Yes ❑ <br /> No <br /> Is the vera poft secondarily contained? ❑Yes ErNo ❑Y ❑res ❑No ❑yea ONO 7 <br /> Overfill Prevention Equipment s! <br /> What Is the overfill preverrtion equipment response hats Flow ❑Shuts Off Flowwhen actvatW ❑Shuts Off Flow <br /> XhKk all that .) ❑Restricts Flow ❑ Flow ❑Restricts F ❑Restricts Flow '.. <br /> ❑AIV Ahmn ❑ ❑AIV Alarm <br /> Are flow resvictars installed on vent piping? 0 Yes ®NO 0 Yes 0N ❑r ❑No [3 Yes ❑No <br /> At vftt level In the tank is me Overfill prevention W — <br /> to activate?(inches ) <br /> What Is this Percent capacity of at <br /> overfill pr ? r?B Q f <br /> Is in t y r respond when the substance reaches the 9yes ❑r <br /> ? ❑ ( ka Y.) ❑P!o( <br /> In V.) ❑No(Sosafy in V.) ❑No(Specify to V.) <br /> . SUMMARY OF INSPECTION RESULTS <br /> Overfill Prevention Inspection Results ❑Feu 1 ❑Pass ❑Feu ❑ ❑Fa'si P ❑Faa <br /> V. MENTS <br /> C <br /> y `Fart'must be exiptamd In this sectidn, Any addilmal cornments may aPso be pro~here. <br /> A CERTIFICATION By UST SERVICE TCFC <br /> In accordance 2E hereby N n equipment inn h lfi , <br /> Division 3.Chapter 16,Sectim 2637.2 and all the Information cwftkwdin Is amurste. <br /> LIST Technician Siginaturs <br /> 11 ftaft has more comporranti—gswn—"tt form r <br /> eccmmodsf or this,Page may be affiechad <br /> Overfill inspection report <br />