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y Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2344236 Date: 3/3/2020 <br /> Site Name/ID: 7-ELEVEN#32262, MKT 2368(N-3940-1 <br /> Address: 2360 W GRANTLINE I-205 OFF RAMP <br /> City: TRACY State: CA Zip: 95376 <br /> How Inspected: Line Test r NFPA 30A r PEI RP1200r Other r <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/Fail Comments <br /> 1/2 87 r P-0 r Pass r Fail r Not Tested <br /> 1/2 89 r W r Pass r Fail r Not Tested <br /> 1/2 91 P P- r Pass r Fail r Not Tested <br /> 3/4 87 W W r Pass r Fail r Not Tested <br /> 3/4 89 r r r Pass r Fail r Not Tested <br /> 3/4 91 W rJ F Pass r Fail r Not Tested <br /> 5/6 87 r W r Pass r Fail r Not Tested <br /> 5/6 89 W W F Pass r Fail r Not Tested <br /> 5/6 91 IO r Pass r Fail r Not Tested <br /> 7/8 87 W r Pass r Fail r Not Tested <br /> 7/8 89 I✓ W W Pass r Fail r Not Tested <br /> 7/8 91 570 W r Pass r Fail r Not Tested <br /> 9/10 87 W r r Pass r Fail r Not Tested <br /> 9/10 89 W r r Pass r Fail r Not Tested <br /> 9/10 91 W r F Pass r Fail r Not Tested <br /> 11/12 87 F W r Pass r Fail r Not Tested <br /> 11/12 89 r W P- Pass r Fail r Not Tested <br /> 11/12 91 W P- r Pass r Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jessus� Saldivar <br /> Signature: '" e^�- <br /> Environmental Compliance for Petroleum Systems <br /> ©2020 Tanknology Inc.,Austin,TX.All rights reserved.tanknology.com <br />