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Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2342150 Date : 9/20 /2019 <br /> Site Name/ID : 7 - ELEVEN # 17334 MKT 2368 ( W747 ) <br /> Address : 4501 N . PERSHING AVE . @ ROSEMARIE LN , <br /> City : STOCKTON State : CA Zip : 95207 <br /> How Inspected : Line Test NFPA 30A W PEI RP1200r Other r <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1 /2 87 r Pass r Fail r Not Tested <br /> 1 /2 91 r Pass r Fail r Not Tested <br /> 3/4 87 W F Pass r Fail r Not Tested <br /> 3/4 91 Pass r Fail r Not Tested <br /> Technician Comments : <br /> Technician Name : Clint Fuhrman <br /> Signature : <br /> Environmental Compliance for Petroleum Systems <br /> @2019 Tanknology Inc. , Austin , TX . All rights reserved . tanknology . com <br />