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Appendix IX <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑ Installation ✓� Repair ❑ 36 Month <br /> 1 . FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10181479 2022-03-03 <br /> Facility Name <br /> Mid City Ca FO Regen <br /> Facility Address City ZIP Code <br /> 13850 Devries Road Lodi 95242 <br /> 12 . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> SunWest Engineering Constructors , Inc (888) 588 -8737 <br /> Mailing Address <br /> 4780 Cheyenne Way , Chino CA 91710 <br /> Service Technician Performing Inspection <br /> Krai .q Kinder <br /> Contractor/Tank Tester License Number <br /> 703190 <br /> ICC Number Expiration Date <br /> 8296393 11 - 18 -2022 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS Overfill Prevention 05/29/2022 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Industry Code Franklin Fueling Defender Flapper Valve <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. 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 /> 03-03-2022 2 <br /> CERS = California Environmental Reporting System , ID = Identification , ICC = International Code <br /> Council , OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />