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WALTON <br /> ENGINEERING, INC. C,51-/O G IOC C�CJ/1��,�JE��l11�i�/� �/�N✓�/O/ti� <br /> Overfill Prevention Inspection -OPW 61 and 71 Series Devices <br /> Date: <br /> Owner: <br /> Facility: <br /> OPW Overfill Model Number: <br /> Part 1 -Proper Height Setting Calculation <br /> Tank 1 Tank 2 Tank 3 Tank 4 <br /> Maximum Tank Volume Per: A Gallons '10319 <br /> Max shut off requirement for flapper is 95% s 9s% 7.S <br /> Multiply Max tank volume by 95% C GO= o,;2 <br /> Use tank chart or ATG to determine height of D Inches /� <br /> calculated volume <br /> Measure top of fill riser threads,or face seal E Inches <br /> adapter <br /> Tank diameter(From Tank Chart) F Inches M I-,/? <br /> Upper Tube in Tank(G)F-D=G G Inches <br /> Subtract 2"from upper tube in tank G-2"=K K Inches O) 1 <br /> Calculated minimum upper tube length(I) I Inches <br /> K+E=I <br /> Actual measured upper tube length(Without <br /> fill adapter) J Inches <br /> Part 2 - Device Certification Criteria Evaluation <br /> Does the overfill prevention device meet the 95% <br /> requirement? <br /> Is the actual measured upper tube length 6.5 inches or <br /> more than the fill riser?(J must be 6.5"or more than E) <br /> Does the overfill.prevention device function as required? <br /> (Inspect the device for damage,contamination,freedom of <br /> movemem weakening due to wear and corrosion <br /> Device Overfill Certification PASS /FA1L <br /> Drop Tube Testing PASS/FAIL <br /> Technician certifies that the device is operationally compliant. <br /> Signature of Technician: Date: <br /> Technician's Name: <br />