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FFSD RO <br /> fill 11110 <br /> Facility Name . " I Owner . <br /> Address 7LILI (K Lr <br /> City, State , Zip Code . & CA CA q4S 2LI ? Phone . <br /> Testing Company. (� n Phone . 610 3 7 Z _ ) g >r Date . 1 Z . f0 ? 3 <br /> Product Grade : <br /> 1. REFER TO THE MANUFACTURER'S TANK CHART. <br /> Tank Volume (gal ) <br /> Tank Diameter Ift) Gi L <br /> 954 Tank Volume (gal ) <br /> ( r Multiply Tank Volume by 0 . 951 <br /> 95 %) Volume Height fin inches ) Based <br /> on Calculation Above <br /> 2. PERFORM THE OVERFILL PREVENTION VALVE INSPECTION. <br /> Inspection performed ? Flapper moves Yes Te, Yes 7 Yes r Yes o Y'es _ Yes <br /> freely into the flow path ? No No No i No i No No <br /> Measure "A ' lin ) . <br /> Subtract " Z " ( in ) D j <br /> Subtract 4 5 in 45 4 . 5 4 . 5 45 4 5 - 4 5 <br /> = Calculated 9500 Final Shutoff 2 2 2 2 2 2 <br /> Volume Height ( in inches) Based on �V <br /> Measurements Above <br /> Difference Between 1 and 2 (equal or <br /> less than = pass, greather than = fad ) 4'1A 5`j <br /> 3. DETERMINE WHETHER THE OVERFILL PREVENTION VALVE INSTALLATION PASSES THE INSPECTION. <br /> Find the Final Shutoff Volume in the <br /> manufacturer 's tank chart . Enter the 4O <br /> closest corresponding volume (gal) . <br /> - Divide by Actual TanN Capacity (gall 7 <br /> Multiply by 100 D CII I <br /> = Equals Final Shutoff Volume % L, ?J 24 T <br /> If the final shutoff volume percentage is 95 % or less , the installation meets FFS and industry recommended practices, This percentage <br /> can , however, exceed 95 % as long as the ullage volume remaining is greater than or equal to 250 gallons so that " none of the fittings <br /> located on the top of the tank are exposed to product due to overfilling " according to EPA 40 CFR, Part 280. The installation must also meet <br /> all applicable regulatory requirements, and must be acceptable to the Authority Having Jurisdiction , <br /> Enter Actual Tank Capacity ( gal ) <br /> Subtract Final Shutoff Volume (gal ) <br /> = Equals Ullage Volume Remaining (gal ) <br /> The OPV passes the installation Yes Yes Yes Yes Yes Yes <br /> inspection ? No No No No No No <br /> 'bmments <br /> Tester 's Name ( print) ` • tit nlLlt,t ( ' 1 Tester's Signature "Li <br /> - tr_ <br />