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W.O.# NW1-2337832 Cust Ref# : COCO-0015297489 <br /> UNDERGROUND STORAGE TANK <br /> OVERFILL PREVENTION EOUWMENT INSPECTION REPORT FORM(Page t aF 1) <br /> Typa of Acf+an —D lft4 A tion In.4eawil ❑fs";air hspodran 36 Mornh 4rWe---, <br /> L FACIIJTY INFORMATICIN <br /> Still <br /> fn Data of Proverdiaa EquiAt1wll Itispi:.Lan <br /> 10182313 1 11-21-15 <br /> OLmir.mm Marm f5urrx as Faoft Narov or ik A-Ekwiq 9iLzvw.%x Ai) <br /> Chevron <br /> Su r r SRw Ad*ien Ciy 74P Coda <br /> 755 S tracy Tracy 95375 <br /> IL UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service TeUnidan Pnrfrrmmq the Insp w1mo fRfkif as 3hotwl on t1w JCi:VL&Vr uunrt) 3�fxxia A <br /> Timothy EIg-:bg§Lt 18001 80(1-4633 Ext <br /> r:cnt=aUnrFSn�i YM%tEr i i nma d IICC C&taumon A tCC CenlifiW4&i Erpif'gkv Carrc <br /> 743180 L 130P1435 1-7 ?:0 <br /> th,erii Prevenhcrl EQulprenf Irr-"'on Traniria and Cnevzgw'om("rr wit.-am-,,--rhrtok=) <br /> fffjp.Vr 5-7-19 <br /> III OVERFILL PREVENTION EQUIPMEWT INSPECTION INFORMATION <br /> Incpectiao A+!^Au d U4kq [�RRdnllleCWft*i,4G F�Rt L YI <br /> Iia tndusigy Code or,Eoomcmg udarJd( - InKe <br /> Aftch tiho mSwcdlon pmcedu ma mrd aN docuatenlyliva r"wred Po ftrp mina mo msuhx. k of A I=fied f Nes <br /> Tank 10:f8Y tmA nwnWr,ztcrW pM0err,rrct 1.91 _ 2-87 - <br /> Wr-rw its"rant ns,de dmrmmr?t1noms! 11775 I 117.75 <br /> x Ine PA prpinq scroWariy(antafrrd^ ! ILS Ye. D tJo ..Ycs ❑M U Ytm !,. NC, Tffy _ _ tut► <br /> :s We:�3nr ppinA smor=nly tontalnw txl Yr_ !::No � F)Yat C[No - L7 res IJ No �Ytis No <br /> 0—Y me izsewc%:wnn Ettvrorner:Maftvi Giurof(%) <br /> 71so 1 71SO <br /> Whar-s the ouarfill prr.+antian equ+prArn Snfala Off s=tow V- Shrift U1t Flow LI Smrta Off Flaw I J shut,Crit now <br /> rra:p=-m-Winn M�tivdleti i ❑Ra:smz nav, V1 fie:t rat 1-1Dw ❑Rmtn=;Fkm LI RwJ,.;%Baw <br /> �Chc-AM dfdt aRupy) C AN AUM !-I AV Al itm DAN aaarm :Ll JVV Atams <br /> Riz Raw W-'dt=M lowalted on VOLS p4pslp7 Q Ya L�Nu ❑Yes ❑Nn O Yrs !E-3 Na Q y4% ❑N4 <br /> Av kirit levet n»re taeh is the morin orevanzw <br /> Lr x3ia91e�rfnc,�ed krssm tntfcurr 98,75 99.5 <br /> of fwM-) <br /> WpW Q tNw pumu"q smparny dthn tmtk at y"1101 !D1% 91% <br /> W*o9F&w Ote'ye"00 fqul anent 3ChfF9 l <br /> Ir 1ne we,1111 pivVef bon W.Im W snel"WIN'Z 21 Yes .0 Yos 'GYes ©Yc; <br /> too pbon Co cV4orA whon IM sr lsrco [j Hrj U Na n No ❑No <br /> lcodt m the appsopra"Immo, Icy it eectfth v_! Ispxrty in socio n v,I (Spa ctr m se al V. ppeedyyi section Y_)_ <br /> IV. SWIMMY OF INWMT10N RESULTS <br /> Ouarfill Pfeventnn lezoecton flesu Q PsiK LJ Fall fuss I�FaH I ©Fx� FaA I iROlb F 0 <br /> - r _ <br /> v _ V. COMMENTS <br /> +4V ilumlrrgw+thrr)'Fut 'nn,�txv rr,t)n4ivaer7 Nt lrprt see:.c�n. +�rW at1tA'tbrra+mrtrma�Cir m.�y a�g tur ptindatrx±rmrr <br /> VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION <br /> 1 haroby CWUIp that We uvarfi1113MVCocwn atimpmem Y"s iv�on ctccordancr with coillarrik Code ur R"utdtlons.ut%'l3.dhri:t, <br /> CI7✓iptEC 16.&BCUQII 253T.T]AQ,TrI ttW Int[IC>tniRlarr tutthrt�d Mrviit is accuraEr <br /> USTSorviceT-amicianSi3rrgure <br /> CUM="doma ErMrCWW Ward p4pcctffollart Llo�r-tWw:1mwvrrfd stlnruL:tarot IGC-IrdowwxA Coni!Oxuwd,AN=Atr3blr..7M Yrurd <br />