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RECEIVED BY EHD: <br /> 7/27/2021 <br /> (received via Crorl Vault Portal) <br /> Overfill Prevention Device Inspection: <br /> Tank# Tank# Tank# Tank# Tank# <br /> 1 Diesel 2 Diesel 3 Biodiesel <br /> All tank top fittings are visually in good condition and vapor tight t+ Yes r No r Yes r No 170 Yes r No r Yes r No <br /> If No, provide additional information: <br /> Ball Roat Valve Present(If No Ball Float, leave next three questions blank) r Yes r No r Yes t'* No r Yes I* No r Yes r No <br /> Ball float valve is in good visual condition. r Yes r No r Yes r No r Yes r No r Yes r No <br /> (Fbmove fitting/cap to visually confirm) <br /> Standard drop tube is properly installed in the tank fill riser. (Y/N) r Yes (* No r Yes C* No r Yes t+ No r Yes r No <br /> Indicate tank capacity when flow restriction occurs. <br /> (%) (%) (%) <br /> (Determined by completing TanknafogyOve Ml PYewntion Equipment 95 95 95 (%) <br /> Inspection form,available in Technidans Rot000ls scan and upload into order) <br /> If No to any of the Ball Float Valve Questions, provide additional information: <br /> Rapper Valve present(Drop Tube Device) (If No Flapper Valve, leave next four questions blank) (* Yes r No l: Yes r No r Yes r No r Yes r No <br /> Flapper valve is not obstructed, <br /> (fbmove tank fill cap and visually confirm) <* Yes r No r Yes r No 170 Yes r No r Yes r No <br /> Tight fill adaptor is installed correctly and in good condition. r* Yes r No ITO Yes r No (* Yes r No r Yes r No <br /> Drop tube assembly is in good condition and all gaskets/seals are in place. t+ Yes r No r Yes r No 170 Yes r No r Yes r No <br /> Indicate tank capacity when complete shut-off occurs <br /> (Determined by completing TANCSOueâ–ºfiill lnsp OPIN Flamer Ualve form) 9s(%) 9s(%) 9s(%) (%) <br /> If No to any of the Flapper Valve Questions, provide additional information: <br /> Inspection Results <br /> 1* Pass r Fail 1+ Pass r Fail r Pass r Fail r Pass r Fail <br /> If No was selected for any of the items above,select Fail <br /> This form may be utilized to document inspection of overfill prevention device in the absence of a manufacturer recommended test form and protocol,or a Sate <br /> approved third party test form and procedure. <br /> WO# 2335977 <br />