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Section 6: Spill and Overfill (cont’d.)

6.b. Overfill Device

#

Complete 2 – 4. Answer (P)ass, (PC), (F)ail or

Tank #

Tank #

Tank #

Tank #

Tank #

1 2

(NA) for 1 and 5 9 Fill drop tube required and observed.

Overfill device present (list all present): Flapper Valve (FV), Ball Float Valve (BFV), High Level Alarm (HLA), Other Describe.

3 4

5

6

7

8

9

Indicate delivery methodgravity (G) or pump flow (PF). Owner/Operator ensures releases due to spilling or overfilling do not occur? For example, product is measured prior to each delivery to ensure enough room in tank for product and all fuel deliveries are monitored. Visually observed overfill device housing, documentation of installation provided, OR certification provided from a certified UST installer attesting to overfill device operability. Tank receives less than 25-gallons of petroleum per delivery or heating oil UST installed prior to 11-4-96 is not required to have an overfill device. Drop Tube Flapper Valve Visual observation indicated flapper valve is present, with no obstruction in the drop tube that would render the device ineffective. * Ball Float Valve / Vent Restrictor Compatible with UST system configuration, delivery, and use. ** Audible External high level alarm only Visual and audible alarm present to the driver at the point of transfer.

(Circle one)

(Circle one)

(Circle one)

(Circle one)

Y/N

Y/N

Y/N

Y/N

(Circle one)

Y/N

Overfill device passes inspection. Question 4 is yes and 1 and 5– 9 (as applicable) are (P) or (PC)

Note: If the answer to any question is No (N) or (F), explain below. List any problems noted during inspection. Note corrections.

*A fill pipe that utilizes a flapper valve in the drop tube for overfill purposes and receives a pressure delivery product drop, shall have a specific flapper valve designed for that use. ** If a UST system has one or more of the following, the owner or operator of the system shall not use a ball float valve on that system: (1) a tank that receives a pumped delivery; (2) suction piping with air eliminator; (3) remote fill pipes and gauge

openings; (4) an emergency generator tank; (5) coaxial drop fill adapter.

Comments: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Form Number: MDE/WAS/COM.055 Date: April 3, 2007 TTY Users: 800-735-2258

Facility I.D.

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