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Appendix IX <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair <br />36 Month <br />210330-006 <br />1. FACILITY INFORMATION <br />CERS ID <br />10181481 <br />Inspection Date <br />04/20/21 <br />Facility Name <br />Manteca CA FO REGEN <br />Facility Address <br />2551 E. Louise Ave. <br />City <br />Lathrop <br />ZIP Code <br />95330 <br />2, SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />SunWest Engineering Constructors, Inc. <br />Phone <br />(888) 588-8737 <br />Mailing Address <br />4780 Cheyenne Way, Chino, CA 91710 <br />Service Technician Performing Inspection <br />Kraig Kinder <br />Contractor/Tank Tester License Number <br />CA -703190 <br />ICC Number <br />8296393 <br />Expiration Date <br />11/18/22 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Franklin Fueling <br />5/29/22 <br />4. INSPECTION <br />PROCEDURES INFORMATION' <br />Inspection Procedures Used <br />Components Inspected <br />Industry Code <br />EBW drop tube <br />Industry Code <br />Pnumercator Automatic tank gauge <br />F <br />tI <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br />1 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 Technician Signature <br />Digitally signed by Kraig Kinder <br />Kraig Kinder 070p202T.g4.2012:42:02 <br />Date <br />04/20/21 <br />Total # of Pages <br />2 <br />CERS =California Environmental Reporting System, ID =Identification, ICC =International Code <br />Council, OPE =Overfill Prevention Equipment <br />Page 1 of 2 <br />