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Impact Valve <br /> ,,jp Tanknology Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2344049 Date : 2 /6/2020 <br /> Site Name/ID : 7 ELEVEN 35355 <br /> Address : 3202 W HAMMER LANE ( N - 136 ) <br /> City: <br /> STOCKTON State : CA Zip : 95209 <br /> How Inspected : Line Test NFPA 30A W PEI RP1200F' Other <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass / Fail Comments <br /> 1 /2 87 I✓ F Pass Fail Not Tested <br /> 1 /2 91 rV Pass Fail NotTested <br /> 3/4 87 F IO Pass Fail Not Tested <br /> 3/4 91 W F Pass Fail Not Tested <br /> 5/6 40 F l✓ W Pass r Fail r Not Tested <br /> 5/6 87 F IV Pass Fail Not Tested <br /> 5/6 91 FV C✓ r Pass Fail r Not Tested <br /> 7/8 40 r Pass Fail )� Not Tested <br /> 7/8 87 r W rV Pass r Fail r Not Tested <br /> 7/8 91 r r Pass Fail Not Tested <br /> Technician Comments : <br /> Technician Name : Jesus Saldivar <br /> Signature : a w <br /> Environmental Compliance for Petroleum Systems <br /> ©2020 Tanknology Inc. , Austin , TX . All rights reserved . tanknology . com <br />