Laserfiche WebLink
Appendix IX 20204729 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION Installation FIRepair F36 Month <br /> L . FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10182141 12/31/2020 <br /> Facility Namef <br /> Arco 2186 <br /> Facility Address City ZIP Code <br /> 3212 N. California Stockton 95204 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Gettler-Ryan Inc. 925-551-7555 <br /> Mailing Address 6805 Sierra Court, Suite G, Dublin, CA 94568 <br /> Service Technician Performing Inspection Terrell Taylor <br /> Contractor/Tank Tester License Number220793 <br /> ICC Number Expiration Date <br /> 9315756 8/23/2021 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root Tech Cert#C27879 7/30/2022 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Tape Measure/Tank Chart Veeder Root TLM Probes <br /> S. 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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total# of Pages <br /> 12/31/2020 2 <br /> CERS = California Environmental Repoing System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />