DERR-2024-011453

Overfill Prevention Equipment Inspection
OPW 61 and 71 Series Overfill Prevention Device Inspection (Non Testable)
Customer Name:
Facility ID #:
Address:
Street
Date:
City, State
Tank Designation 1 2 3
Part 1 - Proper Height Setting Calculation YES NO PASS FAIL
OPW Installation Manual H15524PA Rev L 1/30/2014)
Maximum Tank Volume (Gallons) Shown on customers provided tank chart Gallons 15,041 8,050 7,099
Max Shut off requirement for flapper is 95% %95%95%95%
Multiply maximum tank volume by 95% (Gallons)95%Gallons 14,289 7,648 6,744
Find the dip stick number on the tank chart that corresponds with 95%X Inches 106.000''105.250''106.875''
Measure top of fill riser threads, or face seal adapter A Inches 49.750''48.750''48.500''
Find the Dip Stick Volume that corresponds with 100% (FROM TANK CHART)Y Inches 118.375''118.375''118.375''
Upper Tube in tank (Y) -(X) = (Z)Z Inches 12.375''13.125''11.500''
Subtract 2 inches from upper tube in tank Formula: (Z) - 2" = (C )C Inches 10.375''11.125''9.500''
Calculated minimum upper tube length Formula: (C ) + (A) = Upper Tube Length Calculated Inches 60.125''59.875''58.000''
Actual measured upper tube length (without fill adapter)Actual Inches 61.375''61.875''61.875''
Part 2 - Device Certification Citeria Evaluation
Criteria 1 Does the overfill prevention device meet the 95% requirement?YES YES YES
(If Actual is greater than or equal to calculated ( YES)
(If Actual is less than or equal to calculated ( NO)
Criteria 2 Is the actual measured upper tube length 6.5 inches or more than the fill riser?YES YES YES
(C must be 6.5" if not then the upper tube length is 6.5 plus measurement A)
(For testable models ending in "T" upper tube length is (C)+ (A) - 1 -1/2". If less than 6.5" than
it is 6.5" +(A) - 1-1/2")
Criteria 3 Does the overfill prevention device function function as required?YES YES YES
(Inspect the device for damage, contamination, freedom of
movement, weakening due to wear and corrosion)
Part 3 - Device Certification PASS / FAIL PASS PASS PASS
Technician certifies that the device is operationally compliant.
If the response to Criteria 1, 2, and 3 above are YES.
Date:
OPW 71SO-410C Overfill Drop
Tube Make
and Model
Tank
Chart
Comments:
9/6/2023
Signature of
Technician:
Tank Chart
Provided by
Speedway Number 9432
4002155
524 West 4500 South
Murray, Utah 84123
Xerxes
9/6/2023
PVVC tested ==>RUL Manifolded
Final Test Result (Pass / Fail) ==>Fail
PVVC Manuf. ==>Husky Model Number ==>5885
Is this Original or
Replacement?
Original
If this cap is being
replaced, check here:
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 25 0.0530 Fail
Low High Measured
Pos Cracking (in H2O)2.50 6.00 2.10 Fail
Neg Leak Rate (CFH)0.21 100 0.2120 Fail
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -5.12 Fail
PVVC tested ==>RUL Manifolded
Final Test Result (Pass / Fail) ==>Pass
PVVC Manuf. ==>OPW Model Number ==>723V
Is this Original or
Replacement?
Replacement Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 10 0.0212 Pass
Low High Measured
Pos Cracking (in H2O)2.50 6.00 3.61 Pass
Neg Leak Rate (CFH)0.21 60 0.1272 Pass
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -8.81 Pass
PVVC tested ==>PUL Manifolded
Final Test Result (Pass / Fail) ==>Fail
PVVC Manuf. ==>Husky Model Number ==>5885
Is this Original or
Replacement?
Original
If this cap is being
replaced, check here:
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 25 0.0530 Fail
Low High Measured
Pos Cracking (in H2O)2.50 6.00 1.98 Fail
Neg Leak Rate (CFH)0.21 100 0.2120 Fail
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -4.83 Fail
PVVC tested ==>PUL Manifolded
Final Test Result (Pass / Fail) ==>Pass
PVVC Manuf. ==>OPW Model Number ==>723V
Is this Original or
Replacement?
Replacement Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)0.05 10 0.0212 Pass
Low High Measured
Pos Cracking (in H2O)2.50 6.00 3.58 Pass
Neg Leak Rate (CFH)0.21 60 0.1272 Pass
Low High Measured
Neg Cracking (in H2O)-10.00 -6.00 -8.77 Pass
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
PVVC tested ==> Manifolded
Final Test Result (Pass / Fail) ==>
PVVC Manuf. ==>Model Number ==>
Is this Original or
Replacement?
Manf Spec
(CFH)
Measured
Leak Rate
in ml/Min;
Cracking
(in H2O)
Calc CFH
(ml/min
x
.00212)
Result
(Pass /Fail)
Pos Leak Rate(CFH)
Low High Measured
Pos Cracking (in H2O)
Neg Leak Rate (CFH)
Low High Measured
Neg Cracking (in H2O)
11000 N. MOPAC EXPRESSWAY, SUITE 500, AUSTIN, TX 78759
[phone]
QP-08-03-FF-02 Pressure Vacuum Vent Cap TP-201.1E Field Form
Rev C 1/27/2011
Site Overall Test Results: Pass
Total +ve LR: 0.0424
Total -ve LR: 0.2544

Test Date 9/27/2022
Technician Name David Mathie
WO #2355399
Facility Name / Loc #7-ELEVEN 45957/9432 45957/9432
Street 524 W. 4500 SOUTH State ID 4002155
City, St, Zip MURRAY, UT 84123

Pressure Vacuum Vent Cap Test Form TP-201.1E

Site Diagram
(This site diagram is for reference only and is not drawn to scale)

Work Order:2355399
Site ID / Name:45957/9432 / 7-ELEVEN 45957/9432
Address:524 W. 4500 SOUTH State ID 4002155
City:MURRAY State:UT Zip:84123