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• • <br /> Tanknology Impact Valve rRECEIVED <br /> Inspection <br /> Impact Valve Operational JAM 1018 <br /> Inspection <br /> Work Order: 2334167 Date: 1/4/201gNV1R0NMEN1 AL HEALTH <br /> Site Name/I D: CHEVRON 201761 OEPAR i NEN? <br /> Address: 1103 S. MAIN ST. PERMIT NUMB. N-3315 <br /> City: MANTECA State: CA Zip: 95337 <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/Fail Comments <br /> 1/2 87 P P C Pass r Fail r Not Tested <br /> 1/2 91 rV F f: Pass r Fail r Not Tested <br /> 3/4 87 P r r Pass r Fail r Not Tested <br /> 3/4 91 P P r+ Pass r Fail t"' Not Tested <br /> 5/6 87 r r f« Pass f Fail C Not Tested <br /> 5/6 91 r P ro Pass r Fail r Not Tested <br /> 7/8 87 P P C Pass r Fail r Not Tested <br /> 7/8 91 P- P ro Pass r Fail r Not Tested <br /> 9/10 87 P r t: Pass f Fail r Not Tested <br /> 9/10 91 P I-0 G Pass r Fail r Not Tested <br /> 11/12 87 P P-1 r Pass r Fail r Not Tested <br /> 11/12 91 P r (. Pass r Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jarrod Cooke <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2018 Tanknology Inc.,Austin, TX.All rights reserved.tanknology.com <br />