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UNDERGROUNDSTORAGE TANK OVERFILL PREVENTION EQUIPMENT IN 3PECTION REPORT FORM ( Page 1 of i ) Type of Action ❑ Installation Inspection ❑ Re 3air Inspection x❑ 36 Month Inspection I . FACILITY I qFORMATION CERS ID 10181439 Date of Overfill Prevention Equipment Inspection 4/4/2019 Business Name (Same as Facility Name or DBA-Doing Business As) AG SPANOS JET CENTER Business Site Address City ZIP Code 4800 S AIRPORT WAY STOCKTON 95206 II . UNDERGROUND STORAGE TANK ORVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Inspection (Print as shown on the ICC Certification.) Phone # Felix Ramirez (209 ) 744 - 0112 Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date 08 - 1740 Ex . 03/31 /2020 88830 2I UT 11 /9/2020 Overfill Prevention Equipment Inspection Training and Certifications (List applicable certifications.) FF- FF- EBW , Phil -Tite & EVR Phase 1 1009883708 EX 11 29 -20 OPW 104- 634 Ex 3- 14-2020 Emco 3147 Ex . 11 - 16- 20 VR : B34976 ATG : 7/7/20 Incon 1009883708 Ex 11 -30-20 III . OVERFILL PREVENTION EQUIP ENT INSPECTION INFORMATION Inspection Method 0 Manufacturer Guidelines (Specify) : Used : EMCO ❑ Industry Code or Engineering Standard (Specify) : ❑ Engineered Method (Specify) : Attach the inspection procedures and all documentation required o determine the results. # of Attached Pages 5 TANK ID : (By tank number, stored product, etc.) JET A JET A JET A What is the tank inside diameter? (Inches) 127 120 92 Is the fill piping secondarily contained ? ❑ Yes ❑x No Yes ❑x No ❑ Yes ❑x No ❑ Yes ❑ No Is the vent piping secondarily contained ? ❑ Yes [E No Yes 2 No ❑ Yes 0 No ❑ Yes ❑ No Overfill Prevention Equipment Manufacturer(s) EMCO EMCO EMCO A1100 A1100 A11o0 What is the overfill prevention equipment response ❑x Shuts Off Flow x Shuts Off Flow ❑x Shuts Off Flow ❑ Shuts Off Flow when activated ? (Check all that apply.) ❑ Restricts Flow Restricts Flow ❑ Restricts Flow ❑ Restricts Flow ❑ AIV Alarm AIV Alarm ❑ AIV Alarm ❑ A/V Alarm Are flow restrictors installed on vent piping ? ❑ Yes ❑x No Yes 0 No ❑ Yes [jg No ❑ Yes ❑ No At what level in the tank is the overfill prevention set to activate? (Inches from bottom of tank.) 1 1 6 107 85 What is the percent capacity of the tank at which the overfill prevention equipment activates? 95 % 94% 96% Is the overfill prevention in proper operating condition ❑x Yes Yes ❑ Yes ❑ Yes to respond when the substance reaches the appropriate level? ❑ No (Specify in V.) No (Specify in V.) ❑x No (Specify in V.) ❑ No (Specify in V.) IV. SUMMARY OF INS ECTION RESULTS Overfill Prevention Inspection Results ❑x Pass ❑ Fail Pass ❑ Fail ❑ Pass ® Fail ❑ Pass ❑ Fail V. COMMENTS Any items marked "Fail' must be explained in this section. Any addition I comments may also be provided here. 12000 GALLON TANK NOT SET AT 95 % VI . CERTIFICATION BY UST SERVICE TECH 41CIAN CONDUCTING THIS INSPECTION I hereby certify that the overfill prevention equipment was inspected n accordance with California Code of Regulations , Title 23 , Division 3, Chapter 16, Section 2637 . 2 and all the information contained herein is accurate. UST Service Technician Signature If the facility has more components than this form accommodates, additional copies of this page may be attached. CERS = California Environmental Reporting System, ID = Identification , UST = Underground Sto age Tank, ICC = International Code Council, AIV = Audible and Visual