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Underground Storage Tank Overfill Prevention Equipment Testing Report Form 6. OVERFILL PREVENTION EQUIPMENT DETAILS Test Method Developed by ❑ Manufacturer V Industry Standard ❑ Professional Engineer L) Check this box if Appendix 7.1 continuation page is attached. Tank ID (one OPE per column) T1: Regular T2: Premium T3: Diesel Tank Manufacturer XERXES XERXES XERXES Tank Capacity (Gallons) 10369 10369 10369 Tank Inside Diameter (inches) 117.75 117.75 117.75 Are both vent and tank riser piping 21 yes V yes V Yes ❑ Yes secondarily contained? ❑ No ❑ No ❑ No ❑ No OPE Manufacturer! Model opw opw opw What is the OPE response when activated? ® Shut off A Shut off Z Shut off ❑ Shut off (Check all that apply.) ❑ Restrict J Restrict ❑ Restrict ❑ Restrict ❑Audible 0 Audible ❑ Audible ❑ Audible Visual ❑ Visual ❑ Visual ❑ Visual Are flow restictors installed on vent piping ❑ Yes* ❑ Yes* ❑ Yes* ❑ Yes* that may interfere with the OPE operation? No Z No Z No ❑ No For aud1blelvisual overfill alarms, are they C✓J Yes ❑✓ Yes ✓❑ Yes ❑ Yes clearly .audiblelvisible at the tank fill point? LJ No LJ No LJ No LJ No At what level in the tank does the OPE 102.375 97 activate? (inches from bottom of tank) What is the percent capacity of the tank at 93.5 89.6 which the OPE activates? _ Is the OPE in proper operating condition to Yes Yes Yes ❑ Yes respond when the stored substance reaches the desi nated re ulato level? A No ❑ No ❑ No ❑ No 7. SUMMARY OF TEST RESULTS OPE Test Results ❑ Pass V Pass V Pass ❑ Pass 0 Fail ❑ Fail ❑ Fail ❑ Fail 8. COMMENTS Was not able to test REG. Drop tube do to being seized and needing sec. man,was called into the office * ❑Check this box if flow restrictors interfere with overfill prevention and repairs are required. All tests marked `'Fail" and any repairs made during the test must be described in Section 8. Attach tank chart(s), measurements, calculations; and Ira-Tank Setup report(s) Page 2 of 2