HomeMy WebLinkAboutDERR-2024-013058UST Operator Inspection - Utah
YEAR ________
Facility Name Facility ID
Address Primary Class B Operator
NAME(S) AND INITIALS OF PERSON(S) CONDUCTING MONTHLY INSPECTIONS:
Please respond to ALL of the following questions with a Y (Yes), N (No), or NA (Not Applicable) answer.
Months of the Current Year J F M A M J J A S O N D
Monthly Inspection – Release Detection
1 Release detection equipment is operating with no alarms or other unusual
operating conditions.
2 Records of release detection (tanks and piping) are reviewed and current.
Monthly Inspection – Spill Prevention Equipment
3 Equipment is undamaged, intact and free from defects.
4 Equipment is free from debris, water, or product.
5 Fill Pipe is unobstructed.
6 Fill cap is un-broken and is securely on the fill pipe.
7 Double walled spill prevention equipment - Interstitial area is free from leaks.
Initials of person performing Inspection.
Annual Inspection – Containment Sumps Date of annual Inspection
8 Secondary Containment Sumps
(STP, Dispenser and Transition)
Visual Inspection of sump indicates no damage and it is free from debris, water and fuel.
The penetration fittings for conduits and piping entering the STP Sumps are intact.
9 Double Walled Sumps Interstitial area is free from leaks.
10 Hand-held release detection
equipment
Hand-held release detection equipment (bailer, gauge stick, etc.) is serviceable and
operable.
I certify under penalty of law that I am the Class B Operator referenced above and that I am familiar with information on this form
and that it is true, accurate and was completed in accordance with R311-203-7.
Signature of the Primary Class B Operator (Sign this document after the last inspection of the Current Year)
Date
B Operator #
Turn over for record of Interstitial Monitoring visual inspections and Impressed Current rectifier checks.
Comments/Follow up:
2024
Fast Stop 1118 1200647
1584 W 2700 N, Pleasant View , UT 84404
y y
y y
y y
y y
y y
y y
y y
UST Operator Inspection - Utah – Page 2 of 2
If you perform Interstitial Monitoring on your tanks and/or piping and use a visual check rather than sump or
interstitial sensors for your monthly leak detection, complete the table to document the monthly visual checks.
Months of the Current Year J F M A M J J A S O N D
1 Visual check of the interstitial space of the double-walled tank indicated no
release or unusual operating conditions.
2 Visual check of piping (STP, dispenser and transition) containment sumps
indicates normal function and no indication of water or leaked product.
Impressed Current 60 Day Rectifier Check
Months of the Current Year J F M A M J J A S O N D
Show the date the Impressed Current
system was inspected to ensure the
equipment is running properly
Amperage reading from impressed
current rectifier
Voltage reading from impressed current
rectifier
INSTRUCTIONS
1. The monthly UST system inspections must be conducted by or under the direction of the Primary Class B UST Operator.
2. The Primary Class B UST Operator must alert the UST Owner or Operator of any condition discovered during the monthly visual
inspection that may require follow-up actions.
3. The UST Owner or Operator must maintain a copy of the monthly inspection reports for the most recent 12 months. The records
shall be maintained on-site or off-site at a readily available location.
Ver. 4/14/2016
y y
y y
n a
Tank # / Tank Facility ID / ProductLeak Detection:
UST Monthly Compliance Inspection
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56600
Address:1584 W 2700 N State ID:1200647
Phone
Number:Form Completed By:Larry Vasquez Date:11/18/2024
T4 DSL
T4 DSL
Diesel
T3 ETH
FREE
T3 ETH
FREE
Ethanol Free
Unleaded
T2 PUL
T2 PUL
Premium
T1 RUL
T1 RUL
Unleaded
Tanks:
1 Is release detection equip. operating w/o alarms or unusual conditions? Y N
NA Y N NA Y N NA Y N NA
2 Is tank free of water? Y N
NA Y N NA Y N NA Y N NA
3 Primary Tank Release Detection Method Inspected:Interstitial
Monitoring
Interstitial
Monitoring
Interstitial
Monitoring
Interstitial
Monitoring
4 Date of last passing result:11/18/2024 11/18/2024 11/18/2024 11/18/2024
5 Are Inventories reconciled daily and are the variances within the guideline set by the
facility owner?
Y N
NA Y N NA Y N NA Y N NA
Lines:
6 Are line leak detectors present? Y N
NA Y N NA Y N NA Y N NA
7 LD s operating properly (no slow flow)? Y N
NA Y N NA Y N NA Y N NA
8 Primary Line Release Detection Method Inspected Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
Sump Sensor
Monitoring
9 Date of last passing result:11/18/2024 11/18/2024 11/18/2024 11/18/2024
Fill/Overfill:
10 Fill caps, adapters, gaskets in good condition? Y N
NA Y N NA Y N NA Y N NA
11 Fills properly marked? Y N
NA Y N NA Y N NA Y N NA
12 Spill bucket free of liquid/debris? Y N
NA Y N NA Y N NA Y N NA
13 Spill bucket free of damage/drain work correctly? Y N
NA Y N NA Y N NA Y N NA
14 Does the spill bucket drain assembly work correctly? Y N
NA Y N NA Y N NA Y N NA
15 For double wall spill bucket, is the interstitial monitoring equipment functioning, in
good condition and not in alarm?
Y N
NA Y N NA Y N NA Y N NA
16 Fill cap in place and sealed tightily? Y N
NA Y N NA Y N NA Y N NA
17 Overfill drop tube free of obstructions? Y N
NA Y N NA Y N NA Y N NA
Vapor:
18 Vapor cap in place and sealed tightly? Y N
NA Y N NA Y N NA Y N NA
19 Vapor recovery adapter intact? Y N
NA Y N NA Y N NA Y N NA
20 Vapor recovery lids painted orange? Y N
NA Y N NA Y N NA Y N NA
21 Is Vapor Bucket free of damage and free of liquid/debris? Y N
NA Y N NA Y N NA Y N NA
STP Secondary Containment:
22 Sump containment free of water/fuel/debris? Y N
NA Y N NA Y N NA Y N NA
23 STP and piping free of leaks and seeps? Y N
NA Y N NA Y N NA Y N NA
24 Sump containment free of damage? Y N
NA Y N NA Y N NA Y N NA
25 For DW containment with Brine, are levels correct? Y N
NA Y N NA Y N NA Y N NA
12/4/24, 10:43 AM Monthly Inspection UST CO
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6
26 Sensors located @ lowest point in containment? Y N
NA Y N NA Y N NA Y N NA
Dispensing Equipment:Qty:Facility Notes:
27 UDC free of water/fuel/debris? Y N NA
28 All meters/ piping free from leaks and seeps? Y N NA
29 UDC in good condition & free from damage? Y N NA
30 For DW containment with Brine, are levels correct? Y N NA
31 Sensors located lowest point in UDC? Y N NA
32 Shear valves properly set and secured? Y N NA
33 Nozzles, swivels, hoses and connectors free of
leaks? Y N NA
34 All product and whip hoses in good condition? Y N NA
Cathodic Protection:
35 Rectifier is on? Y N NA
Contractor Signature:Date:11/18/2024
Printed Name:Larry Vasquez Certification Number:
12/4/24, 10:43 AM Monthly Inspection UST CO
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Automatic Tank Gauge Inspection
ATG 1
ATG 1743
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56602
Address:1584 W 2700 N, Pleasant View , UT, 84404 State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/18/2024
ATG Console Inspection
Tank Level Monitor Brand :Veeder Root
1.Status upon Arrival:All Functions Normal
2.Status upon Departure:All Functions Normal
3.Is the display in good
condition and functioning?:
Yes
4.Is the keypad in good
condition?:
Yes
Tank Level Monitor Model :TLS-450 Plus
5.Are all indicator lights
functional?:
Yes
6.Is printer functional?:Yes
7.Back-up battery tested? (if
applicable)?:
Yes
8.Back-up battery voltage (if
applicable):
Tank Information
Probe and Programing Inspection:
9.Tank # T1 RUL T2 PUL T4 DSL T3 ETH FREE
10.Tank Facility ID T1 RUL T2 PUL T4 DSL T3 ETH FREE
11.Tank # per ATG T1 RUL T2 PUL T4 DSL T3 ETH FREE
12.Product:Unleaded Premium Diesel Ethanol Free
Unleaded
13.Tank Volume, gallons 14881 4706 4706 4190
14.Tank Dia/depth, inches 90.5 90.5 90.5 90.5
In-Tank Setup Parameters:
15.Thermal coefficient .000700 .000700 .00450 .000700
16.ATG Programmed Diameter 90.5 90.5 90.5 90.5
17.Number of points on profile 4 4 4 4
18.Full volume on profile 14881 4706 4706 4190
12/4/24, 10:44 AM ATG
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Pass/Fail Criteria: if any of questions 19, 20 ,21 & 22 are No, then the system has failed the test.
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
19.After removing the probe from the tank, it has been inspected and any
damaged or missing parts replaced?
Yes Yes Yes Yes
20.Do floats move freely along the stem without binding?Yes Yes Yes Yes
21.Does product level match console value?Yes Yes Yes Yes
22.Does water level match console value?Yes Yes Yes Yes
23.Water warning (inches)(1")1.5 1.5 1.5 1.5
24.High water limit (inches)(1.5")2.5 2.5 2.5 2.5
25.Does console water alarm trigger at programmed level?Yes Yes Yes Yes
26.Programmed Overfill Limit (90%)90 90 90 90
27.Does console overfill alarm trigger at programmed level?Yes Yes Yes Yes
28.Programmed High Product Limit (95%)95 95 95 95
29.Does console high product alarm trigger at programmed level?Yes Yes Yes Yes
30.Low Product (15% of tank volume or 15" whichever is greater)15 15 15 15
31.Tank test program enabled?Yes Yes Yes Yes
32.Tank Test Method?Interstitial Interstitial Interstitial Interstitial
33.Tank Test Rate 0.2 0.2 0.2 0.2
34.Test duration (hrs)CONT CONT CONT CONT
35.12 months of tank test history present?Yes Yes Yes Yes
Lines:
36.Electronic Line Leak Type PLLD PLLD PLLD PLLD
37.Line # and label in ATG (Q1, Unleaded)Q1 Q2 Q4 Q3
38.Line Test Rate 0.2 GPH 0.2 GPH 0.2 GPH 0.2 GPH
39.12 months of line test history present?Yes Yes Yes Yes
40.Test Result Pass Pass Pass Pass
12/4/24, 10:44 AM ATG
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Automatic Tank Gauge Sensor
ATG 1
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56604
Address:1584 W 2700 N, Pleasant View , UT, 84404 State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/18/2024
Sensor: #
Brand:Veeder Root Veeder Root Veeder Root Veeder Root Veeder Root
Model:Piping Sump
Sensor
Non-
Discriminating
Interstitial Sensor
Piping Sump
Sensor
Piping Sump
Sensor
Piping Sump
Sensor
Type:Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Location:STP INT STP STP STP
Test Liquid, Fuel(F) and/or Water(W):Both Both Both Both Both
Is the ATG console clear of any active
or recurring warnings or alarms
regarding sensor?
If sensor is in alarm and functioning
indicate why below:
Y Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y Y
Has the sensor been inspected and in
good operating condition?
Y Y Y Y Y
When placed in the test liquid does the
sensor trigger an alarm?
Y Y Y Y Y
Sensor removed for testing?Y Y Y Y Y
When an alarm is triggered, is the
sensor properly identified on the ATG
console?
Y Y Y Y Y
Sensor returned to proper placement
and verified to be functional after
testing?
Y Y Y Y Y
Any "No" answers above indicates the
sensor fails the test.
Test Result Pass Pass Pass Pass Pass
12/4/24, 10:44 AM ATG Sensor
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Sensor: #
Brand:Veeder Root Veeder Root Veeder Root Veeder Root Veeder Root
Model:Non-
Discriminating
Interstitial Sensor
Piping Sump
Sensor
Piping Sump
Sensor
Piping Sump
Sensor
Piping Sump
Sensor
Type:Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Non-
discriminating
Location:INT UDC UDC UDC UDC
Test Liquid, Fuel(F) and/or Water(W):Both Both Both Both Both
Is the ATG console clear of any active
or recurring warnings or alarms
regarding sensor?
If sensor is in alarm and functioning
indicate why below:
Y Y Y Y Y
Is the sensor alarm circuit operational?Y Y Y Y Y
Has the sensor been inspected and in
good operating condition?
Y Y Y Y Y
When placed in the test liquid does the
sensor trigger an alarm?
Y Y Y Y Y
Sensor removed for testing?Y Y Y Y Y
When an alarm is triggered, is the
sensor properly identified on the ATG
console?
Y Y Y Y Y
Sensor returned to proper placement
and verified to be functional after
testing?
Y Y Y Y Y
Any "No" answers above indicates the
sensor fails the test.
Test Result Pass Pass Pass Pass Pass
Sensor: #
Brand:Veeder Root Veeder Root
Model:Piping Sump
Sensor
Piping Sump
Sensor
Type:Non-
discriminating
Non-
discriminating
Location:UDC UDC
Test Liquid, Fuel(F) and/or Water(W):Both Both
Is the ATG console clear of any active or recurring warnings or alarms regarding sensor?
If sensor is in alarm and functioning indicate why below:
Y Y
Is the sensor alarm circuit operational?Y Y
Has the sensor been inspected and in good operating condition?Y Y
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When placed in the test liquid does the sensor trigger an alarm?Y Y
Sensor removed for testing?Y Y
When an alarm is triggered, is the sensor properly identified on the ATG console?Y Y
Sensor returned to proper placement and verified to be functional after testing?Y Y
Any "No" answers above indicates the sensor fails the test.
Test Result Pass Pass
Comment
Operator Certification
Contractor Signature:Printed Name:Larry Vasquez
12/4/24, 10:44 AM ATG Sensor
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Leak Detector
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56599
Address:1584 W 2700 N, Pleasant View, UT, 84404 State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/18/2024
Tank Information
Tank #:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Capacity:14881 4706 4190 4706
Product:Unleaded Premium Ethanol Free
Unleaded Diesel
Line #:Q1 RUL T2 PUL Q3 ETH FREE Q4 DSL
Line Type:Pressure Pressure Pressure Pressure
LD Brand:Veeder Root Veeder Root Veeder Root Veeder Root
LD Model:PLLD PLLD PLLD PLLD
Serial #:0 0 0 0
Associated Tank:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Resiliency (ml):0 0 0 0
Check Valve Holding PSI:0 0 0 0
Opening Time:2 0 0 2
Result:Pass Fail Fail Pass
Test Equip. Mfg.:Vaporless, LDT-890 Vaporless, LDT-890 Vaporless, LDT-890 Vaporless, LDT-890
Notes: PUL and ETH Free Failed to Detect that test was going on ran a manual test from ATG and Still No Reaction From Leak
Detector and ATG.
Tested per manufacturer specifications.
Contractor Signature:Printed Name:Larry Vasquez
Line Test
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56598
Address:1584 W 2700 N State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/18/2024
Tank Test Information
Tank #:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Capacity:14881 4706 4190 4706
Product:Unleaded Premium Ethanol Free
Unleaded
Diesel
Line Test Information
Line #:Q1 RUL T2 PUL Q3 ETH FREE Q4 DSL
LineType:Pressure Pressure Pressure Pressure
Line Material:DW FRP DW Flex DW Flex DW Flex
Line ID Size (in):2 2 2 2
Line Length (ft):205 205 205 205
Pump Type:FE Petro FE Petro FE Petro FE Petro
Associated Tank:T1 RUL T2 PUL T3 ETH FREE T4 DSL
Test Equip. Mfg.:Triangle Triangle Triangle Triangle
Test Pressure (PSI):50 50 50 50
Initial Cyl. Level:300 250 400 210
Final Cyl. Level:270 230 400 180
Change in Time (mins):15 15 15 15
Change in Vol:-30.0000 -20.0000 0.0000 -30.0000
Change in Temp (F):0 0 0 0
Coeff. Of Thermal Expansion (g/F):0.00070 0.00070 0.00070 0.00045
Line Vol (gal):33.44 33.44 33.44 33.44
Leak Rate (GPH):-0.0317 -0.0211 0.0000 -0.0317
Result:Pass Pass Pass Pass
Notes
TIGHTNESS TESTING CERTIFICATION
CGRS certifies that the systems in the above table have been tested utilizing leak detection methods which meet the prescribed leak rate testing
standard of 0.10 gph with a minimum probability of detection of 95% and a 5% probability of a false alarm. CGRS further certifies that the protocol for
each test method was strictly adhered to, and that all precision tightness testing performed by CGRS was conducted in accordance with EPA 40 CFR
parts 280.43(c) and 280.44(b) and the National Fire Protection Association, Bulletin NFPA 329 criteria.
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:TMI-301
12/4/24, 10:45 AM Line Test
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Spill Bucket Test
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56601
Address:1584 W 2700 N, Pleasant View , UT, 84404 State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/18/2024
Spill Bucket Information
Tank #Spill Bucket T1
RUL
Spill Bucket T2
PUL
Spill Bucket T3
ETH FREE
Spill Bucket T4
DSL
Vapor Bucket T1
RUL vapor
Tank Facility ID:T1 RUL T2 PUL T3 ETH FREE T4 DSL T1 RUL
Product:Unleaded Premium Ethanol Free
Unleaded
Diesel Unleaded
Spill Bucket Capacity:5 gal 5 gal 5 gal 5 gal 5 gal
Manufacture:OPW OPW OPW OPW OPW
Construction:DW DW DW DW DW
Spill Bucket Type?Product Product Product Product Vapor
Liquid and debris removed from spill bucket?Yes Yes Yes Yes Yes
Visual Inspection (No cracks, loose parts or
separation
of the bucket from fill pipe)
Pass Pass Pass Pass Pass
Tank riser cap included in test?Yes Yes Yes Yes Yes
Is drain valve included in test?Yes Yes Yes
Start Level 15 15 15 15 15
End Level 14.90 14.89 14.90 14.98 14.94
Test Duration (hh:mm)01:00 01:00 01:00 01:00 01:00
Level Change -0.1000 -0.1100 -0.1000 -0.0200 -0.0600
Pass/Fail Criteria (Test Method):Vacuum: maintain
at least 12in WC
Vacuum: maintain
at least 12in WC
Vacuum: maintain
at least 26in WC
Vacuum: maintain
at least 12in WC
Vacuum: maintain
at least 12in WC
Test Result:Pass Pass Pass Pass Pass
Tank #Vapor Bucket T2
PUL
Vapor Bucket T3
ETH FREE
Tank Facility ID:T2 PUL T3 ETH FREE
Product:Premium Ethanol Free
Unleaded
Spill Bucket Capacity:5 gal 5 gal
Manufacture:OPW OPW
Construction:DW DW
Spill Bucket Type?Vapor Vapor
Liquid and debris removed from spill bucket?Yes Yes
Visual Inspection (No cracks, loose parts or separation
of the bucket from fill pipe)
Pass Pass
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Tank riser cap included in test?Yes Yes
Is drain valve included in test?Yes Yes
Start Level 15 15
End Level 14.88 14.9
Test Duration (hh:mm)01:00 01:00
Level Change -0.1200 -0.1000
Pass/Fail Criteria (Test Method):Vacuum: maintain
at least 26in WC
Vacuum: maintain
at least 12in WC
Test Result:Pass Pass
Comments
Operator Certification
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:
12/4/24, 10:46 AM Spill Bucket Test
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If any answers in Questions 3,4,5,6,7,11,13 or 14 are No, the system has failed the test.
Overfill Alarm Inspection
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56605
Address:1584 W 2700 N, Pleasant View, UT, 84404 State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/19/2024
Overfill Alarm Information
This procedure is to determine wheather the high level alarm is operational and will trigger when the tank is no more than 90% full. See PEI/RP1200
Section 7.3 for inspection procedure. This procedure is applicable to tank level monitor stems that touch the bottom of the tank when in place.
Tank #T1 RUL T2 PUL T3 ETH FREE T4 DSL
Tank Facility ID T1 RUL T2 PUL T3 ETH FREE T4 DSL
Product Stored Unleaded Premium Ethanol Free
Unleaded
Diesel
Tank Level Brand Veeder Root Veeder Root Veeder Root Veeder Root
Tank Level Model TLS-450 Plus TLS-450 Plus TLS-450 Plus TLS-450 Plus
1. Tank Diameter, in 90.500 90.500 90.500 90.500
2. Actual Tank Capacity, gal 14881 4706 4190 4706
3.Overfill alarm activates in the test mode at
the console?
Y Y Y Y
4.When activated, overfill alarm can be heard
or seen while delivering to the tank?
Y Y Y Y
5.After removing the probe, it has been inspected
and any damage or missing parts replaced?
Y Y Y Y
6. Float moves freely on stem without binding?Y Y Y Y
7. Moving product level float up stem triggers alarm?Y Y Y Y
8.Inch level from bottom of stem when 90% alarm is
triggered
81.45 81.45 81.45 81.45
9. Calculated tank volume from Question 8 13392 4003 3691 4006
10. Tank % full 89.99 85.06 88.09 85.13
11. Is Question 10 less than 90%Y Y Y Y
12.Fuel float level on the console agrees with the
gauge stick reading?
Y Y Y Y
13. Overfill activates at 90% or less of tank capacity?Y Y Y Y
14.Fuel float level on the console agrees with the
gauge stick reading
Y Y Y Y
Test Results Pass Pass Pass Pass
Comments
12/4/24, 10:47 AM Overfill Alarm Inspection
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Operator Certification
Contractor Printed Name:Larry Vasquez Contractor Signature:
12/4/24, 10:47 AM Overfill Alarm Inspection
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UST Overfill Equipment Inspection
Facility Information
Name:Fast Stop 1118 Certification/Inspection #:56603
Address:1584 W 2700 N, Pleasant View , UT, 84404, Pleasant
View, UT, 84404
State ID:1200647
Phone Number:Form Completed By:Larry Vasquez Date:11/18/2024
Tank Information
1.Tank #T1 RUL T2 PUL T3 ETH FREE T4 DSL
2.Tank Facility ID T1 RUL T2 PUL T3 ETH FREE T4 DSL
3.Product Unleaded Premium Ethanol Free
Unleaded
Diesel
4.Nominal Capacity, gallons 14881 4706 4190 4706
5.Actual Capacity, gallons 14881 4706 4190 4706
6.Req. Shutoff %95 95 95 95
7.Calculated Shutoff Vol., gallons 14136.95 4470.70 3980.50 4470.70
8.Calculated Shut-off Level, inches 81.5 87.87 80.62 87.87
9.Drop Tube Length, inches 131.5 128.5 131.5 134
10.Top of Droptube to Shutoff Level, inches 51.5 49.5 50.5 53
11.Tank Dia/depth, inches 90.5 90.5 90.5 90.5
12.Riser Length, inches 38 36 39.75 36.75
13.Measured Shut-off Level, inches 77 77 79.75 74.25
14.Overfill Prevention Device Brand Franklin fueling
systems
Franklin fueling
systems
Franklin fueling
systems
Franklin fueling
systems
15.Overfill Type Drop Tube Flapper
valve
Drop Tube Flapper
valve
Drop Tube Flapper
valve
Drop Tube Flapper
valve
Automatic Shutoff Device Inspection
16.Drop tube removed from tank?Yes Yes Yes Yes
17.Drop tube and float mechanisms are free of debris?Yes Yes Yes Yes
18.Float moves freely without binding and poppet moves into
flow path?
Yes Yes Yes Yes
19.Bypass valve in the drop tube is open and free of blockage
(if present)?
Yes Yes Yes Yes
20.Flapper is adjusted to shut off flow at required shutoff
capacity?
Yes Yes Yes Yes
Ball Float Valve Inspection
21.Tank top fittings are vapor-tight and leak-free?NA NA NA NA
22.Ball float cage free of debris?NA NA NA NA
23.Ball is free of holes and cracks and moves freely in cage?NA NA NA NA
24.Vent hole in pipe is open and near top of tank?NA NA NA NA
25.Ball float pipe is proper length to restrict flow at required
shutoff capacity?
NA NA NA NA
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26.Test Result Pass Pass Pass Pass
Manufacture's suggested procedures were used.
Comments
Operator Certification
Contractor Printed Name:Larry Vasquez Contractor Signature:
Certification Number:
12/4/24, 10:46 AM UST OverFill
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