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Impact Valve <br /> .LAP Tanknology Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2352101 Date: 10/22/2021 <br /> Site Name/ID: 7-Eleven 38877 <br /> Address: 1515 E Main St <br /> City: Stockton State: CA Zip: 95205 <br /> How Inspected: Line Test F NFPA 30A I- PEI RP 1200 W Other (- <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 W F TY-1 Pass r- Fail F Not Tested <br /> 1/2 91 Wo rv- r Pass r- Fail F Not Tested <br /> 3/4 40 Io W r Pass r- Fail r Not Tested <br /> 3/4 87 IV7 FY-1 WO Pass r- Fail r- Not Tested <br /> 3/4 91 I� W r Pass r Fail r Not Tested <br /> 5/6 87 Wo r ry-1 Pass r- Fail F Not Tested <br /> 5/6 91 P-1 r r Pass .F Fail r Not Tested <br /> 7/8 87 Wo r r Pass r- Fail r Not Tested <br /> 7/8 91 P-1 FY-1 WO Pass F Fail F Not Tested <br /> 9/10 87 Io FV r Pass F Fail F Not Tested <br /> 9/10 91 Wo FY-1 Pass F Fail F Not Tested <br /> 11/12 40 P-1 ry-, r Pass F Fail F Not Tested <br /> 11/12 87 Wo r P Pass F Fail F Not Tested <br /> 11/12 91 Wo Wo WO Pass F Fail I- Not Tested <br /> Technician Comments: <br /> Technician Name: Jess/us Saldivar A <br /> Signature: j'.- <br /> Environmental Compliance for Petroleum Systems <br /> ©2021 Tanknology Inc.,Austin, TX.All rights reserved. tanknology.com <br />