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,LeTanknology Impact Valve <br /> w Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2343353 Date: 1/10/2020 <br /> Site Name/ID: CHEVRON#201383(N-2515-1-1) <br /> Address: 1960 W. 11TH STREET @ CORRAL HOLLOW <br /> City: TRACY State: CA Zip: 95376 <br /> How Inspected: Line Test r NFPA 30A F PEI RP1200r Other r <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/Fail Comments <br /> 1/2 87 r W V Pass r Fail r Not Tested <br /> 1/2 91 W W W Pass r Fail r Not Tested <br /> 3/4 87 W f 7 r70 Pass r Fail r Not Tested <br /> 3/4 91 W W F Pass r Fail r Not Tested <br /> 5/6 87 F7 r F Pass r Fail r Not Tested <br /> 5/6 91 W r r Pass r Fail r Not Tested <br /> 7/8 87 W W P-1 Pass r Fail r Not Tested <br /> 7/8 91 rvo- W F-0 Pass r Fail r Not Tested <br /> 9/10 40 F7 W W Pass r Fail r Not Tested <br /> 9/10 87 W 170 W Pass r Fail r Not Tested <br /> 9/10 91 W W F Pass r Fail r Not Tested <br /> 11/12 40 W I✓ W Pass r Fail r Not Tested <br /> 11/12 87 Wo W W Pass r Fail r Not Tested <br /> 11/12 91 W r W Pass r Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jesus Saldivar <br /> Signature: Al OL- <br /> Environmental Compliance for Petroleum Systems <br /> @2020 Tanknology Inc.,Austin,TX.All rights reserved.tanknology.com <br />