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INSPECTION WORKSHEET Facility Name: owner: Address: City,State,Zip Code: Phone: Testing Company: Phone: Date: Product Grade: 1.REFER TO THE MANUFACTURER'S TANK CHART. Tank Volume(gal) Tank Diameter(ft) 95%Tank Volume(gal) (x Multiply Tank Volume by 0.95) 95%Volume Height(in inches)Based 1 1 1 1 1 1 on Calculation Above 2.PERFORM THE OVERFILL PREVENTION VALVE INSPECTION. Inspection performed?Flapper moves Yes Yes ❑ Yes Yes ❑ Yes ❑ res o freely into the flow path? No No ❑ No No ❑ No ❑ No Measure"A'(in) Subtract"Z"(in) Subtract 4.5 in -4.5 -4.e -4.5 -4.5 45 45 =Calculated 95% Final Shutoff 2 2 2 2 2 2 Volume Height(in inches)Based on Measurements Above Difference Between t and 2(equal or less than=pass,greather than=fail) 3.DETERMINE WHETHER THE OVERFILL PREVENTION VALVE INSTALLATION PASSES THE INSPECTION. Find the Final Shutoff Volume in the manufacturer's tank chart.Enter the closest corresponding volume(gap. Divide by Actual Tank Capacity(gal) x Multiply by 100 =Equals Final Shutoff Volume% If the final shutoff volume percentage is 95%or less,the installation meets FFS and industry recommended practices.This percentage 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 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 all applicable regulatory requirements,and must be acceptable to the Authority Having Jurisdiction. Enter Actual Tank Capacity(gal) Subtract Final Shutoff Volume(gal) =Equals UllageVolume Remaining(gal) The OPV passes the installation Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ Yes ❑ inspection? No ❑ No ❑ No ❑ No ❑ No ❑ No ❑ Comments: Tester's Name(print) Tester's Signature w19