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a L/� 5� P c✓'WLJI�C�D , L�71 1 1 1rHi'�'I <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Ins ection Report Form <br /> 6. OVERFILL PREVENTION EQUIPMENT DETAILS <br /> Ta nk I D (One OPE per column) <br /> Are both vent and tank riser piping Yes ❑ Yes ❑ Yes ❑ Yes <br /> secondarily contained? ❑ No ❑ No ❑ No ❑ No <br /> OPE Model ,,, d✓ <br /> Tank Manufacturer <br /> Shuts off ❑ Shuts off ❑ Shuts off ❑ Shuts off <br /> Flow Flow Flow Flow <br /> What is the OPE response when ❑ Restricts ❑ Restricts ❑ Restricts ❑ Restricts <br /> activated? Flow Flow Flow Flow <br /> (Check all that apply.) ❑ 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 ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> piping that may interfere with the OPE prNo ❑ No ❑ No ❑ No <br /> operation? <br /> At what level in the tank is the OPE set to j ok0 <br /> activate? (Inches from bottom of tank) <br /> What is the percent capacity of the tank in <br /> which the OPE activates? <br /> Is the OPE in proper operating condition Yes ❑ Yes ❑ Yes ❑ Yes <br /> to 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 Ef Pass ❑ Pass ❑ Pass ❑ Pass <br /> ❑ Fail ❑ Fail ❑ Fail ❑ Fail <br /> Page 2 of 3 <br />