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Appendix IX 22204981 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION Installation FIRepair a36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID I01B1253 Inspection Date <br /> 10/12/2022 <br /> Facility Name <br /> Arco 6080 <br /> Facility Address City ZIP Code <br /> 85 E. Louise Ave. Lathrop 95330 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Gettler-Ryan Inc. 925-551-7444 <br /> Mailing Address <br /> 5805 Sierra Court, Suite Q, Dublin, CA 94558 <br /> Service Technician Performing Inspection Darnell Smith <br /> Contractor/Tank Tester License Number <br /> 220793 <br /> ICC Number Expiration Date <br /> 8709494 11/17/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW UST EVR Phase 1 Tech Cert #0174705 7/5/2024 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Tank Chart/Tape Measure Flapper Valves <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 /> 10/12/2022 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />