Laserfiche WebLink
Appendix IX <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION Ej Installation ® Repair Q 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10339507 11/19/2020 <br /> Facility Name <br /> Arco 7049 <br /> Facility Address City ZIP Code <br /> 800 E. Kettleman Lane Lodi 195240 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Gettler-Ryan Inc. (925)551-4777 <br /> Mailing Address <br /> 6805 Sierra Ct.,Suite G, Dublin, CA <br /> Service Performing Inspection <br /> Darnell Smith <br /> Contractor/Tank Tester License Number <br /> 220793 <br /> ICC Number Expiration Date <br /> 8709494 111/23/2021 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root Tech Cert#B48857 3/23/2022 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Tank Chart/Tape Measure Probes <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> I hereby certify that the OPE was inspected in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.2; that required supporting <br /> documentation is attached; and all information contained herein is accurate. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Tech Signatur / Date Total# of Pages <br /> , I +--r'�l� 11/19/2020 2 <br /> CERS = California Environmental Reporting System ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />