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Appendix IX <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> 6. OVERFILL PREVENTION EQUIPMENT DETAILS <br /> Tank ID one OPE percolumn T-1/ <br /> Are both vent and tank riser piping ® Yes ❑ Yes ❑ Yes ❑ Yes <br /> secondarily contained? ❑ No ❑ No ❑ No ❑ No <br /> OPE Model EBW <br /> What is the OPE response when activated? ® Shuts off ❑ Shuts off ❑ Shuts off ❑ Shuts off <br /> (Check all that apply.) Flow Flow Flow Flow <br /> ❑ Restricts ❑ Restricts ❑ Restricts ❑ Restricts <br /> Flow Flow Flow Flow <br /> [:1 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 piping ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> that may interfere with the OPE operation? ® No ❑ No ❑ No ❑ No <br /> At what level in the tank is the OPE set to 43 <br /> activate? (Inches from bottom of tank) <br /> What is the percent capacity of the tank at 95 <br /> which the OPE activates? <br /> Is the OPE in proper operating condition to ® Yes ❑ Yes ❑ Yes ❑ Yes <br /> respond when the stored substance reaches <br /> the designated regulatory level? E] No El No E] No El No <br /> 7. SUMMARY OF TESTING RESULTS <br /> ® Pass ❑ Pass ❑ Pass ❑ Pass <br /> OPE Inspection Results <br /> ❑ Fail El Fail El Fail El Fail <br /> 8. COMMENTS <br /> Are Flow Restrictors Installed? ❑ Yes ❑ Yes ❑ Yes ❑ Yes <br /> No ❑ No ❑ No ❑ No <br /> Describe all results marked "Fail"and each proposed remedy. <br /> * Mark here if: <br /> ❑ Flow restrictors interfere with overfill prevention and equipment repairs required. <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 2 of 5 <br />