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Facility Name: <br />VERIZON-MANTECA CO <br />D. Tank Top/Associated Hardware: General Notes: <br />Dipstick: <br />YES <br />Annular Space Lid/Cap/Seals: <br />OK <br />Manhole Street Lid-Bolts/Seals: <br />OK <br />Manhole Ports/Seals: <br />OK <br />E. Fill Buckets: General Notes: <br />Lid/0-Ring: <br />OK <br />Drain Valve: <br />OK <br />Cap -O -Ring: <br />OK <br />Cap Adaptor: <br />OK <br />Drop Tube: <br />OK <br />Mechanical Overfill Valve: <br />OK <br />Striker Plate Confirmed? <br />OK <br />F. Sumps/Annular/Trenches: General notes: <br />General Cleanliness: <br />OK <br />Sump Riser/Tank Collar Connection penetrations: <br />OK <br />Sump Shields/Water Tight Lids/"Hat"or "Plugs"? <br />OK <br />Piping Visual Inspection: <br />OK <br />Conduit, J Box, Seal Offs, Inspection: <br />OK <br />Probe/Cap Wire Condition: <br />OK <br />1Report Number: 108 10 14-009]Datej <br />Tank 1 I Tank 2 1 Tank 3 <br />In Tank Water Eliminator: /A <br />G. Dispenser: /A Pump I <br />Dispenser Pan: <br />Dispenser Piping: <br />Dispenser Impact Valve Location and operation <br />Nozzle Condition and Operation: <br />Nozzle Hose Condition and Operation: <br />Hose Retractor Condition and Operation: <br />Does Emergency shut off switch work? ( Refueling Site Only) <br />Is The Electronic In -Line Leak Detector Present and Tested? <br />Does Turbine Shut Down if System Detects a Leak? <br />Does Positive Shut Down Occur If Monitoring System is Turned Off? <br />Slab Condition: OK Notes: <br />Traffic Condition: WAVY Notes: <br />Rain/irrigation Run Off: OK Notes <br />Photos Taken? O Notes: <br />Monitoring Equipment Certified? LES Notes: <br />Certified tester's ID#: 5256842 -UT <br />A <br />Pump 2 I Pump 3 <br />Tank 4 <br />Pump 4 <br />Signature Of Certified Technician: Testing Company: Sunwest Engineering Constructors, Inc. <br />Printed Name Of Technician: RUDY ALM4ZAN I Telephone: 909-594-9850 <br />All Certification Data Must Be Attached To Verify Above Information <br />