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Impact Valve <br />Inspection <br />Impact Valve Operational <br />Inspection <br />Work Order: 2310197 Date 4/24/2013 <br />Site Name/ID: CHEVRON 307709 <br />Address: 10858 TRINITY PKWY <br />City: STOCKTON State: CA Zip: 95219 <br />Dispenser <br />Number <br />Grade <br />Secure <br />Mount? <br />Valve <br />Lock? <br />Pass/ Fail <br />Comments <br />1/2 <br />87 <br />r <br />W <br />Pass f ' Fail i` Not Tested <br />1/2 <br />91 <br />FV -1 <br />W <br />r Pass i Fail Not Tested <br />3/4 <br />55 <br />rV <br />W <br />Pass C' Fail Not Tested <br />3/4 <br />87 <br />� <br />ry <br />f+' Pass Fail r Not Tested <br />3/4 <br />91 <br />W <br />W <br />ro Pass r Fail (` Not Tested <br />5/6 <br />87 <br />W <br />W <br />is Pass r Fail r Not Tested <br />5/6 <br />91 <br />ry <br />f: Pass f Fail Not Tested <br />7/8 <br />87 <br />TY -0 <br />t: Pass r Fail Not Tested <br />7/8 <br />91 <br />W <br />)✓ <br />is Pass r Fail Not Tested <br />9/10 <br />87 <br />W <br />r <br />Pass f Fail Not Tested <br />9/10 <br />91 <br />� <br />I✓ <br />Pass Fail Not Tested <br />11/12 <br />55 <br />W.0 <br />W <br />Pass ` Fail Not Tested <br />11/12 <br />87 <br />% <br />i✓ <br /><+ Pass C FailNot Tested <br />11/12 <br />91 <br />)✓ <br />r <br />Pass (" Fail Not Tested <br />Technician Comments: <br />Technician Name: <br />Signature: <br />Jarrod Cooke <br />Environmental Compliance for Petroleum Systems <br />©2013 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com <br />