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.1i Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2353218 Date: 1/12/2022 <br /> Site Name/ID: CHEVRON 210997 (N-4693) <br /> Address: 1442A COLONY DR. <br /> City: RIPON State: CA Zip: 95366 <br /> How Inspected: Line Test F NFPA 30A F PEI RP1200 W Other F <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 Wo Wo F7 Pass r- Fail r Not Tested <br /> 112 91 F70 F7 W Pass r- Fail r- Not Tested <br /> 3/4 87 P-1 F7 W Pass r- Fail F Not Tested <br /> 3/4 91 W F-0 F%O- Pass r- Fail r- Not Tested <br /> 5/6 87 I%O Wo W Pass r- Fail r- Not Tested <br /> 5/6 91 W W W Pass r- Fail r- Not Tested <br /> 7/8 87 P-1 W W Pass F Fail ,F Not Tested <br /> 7/8 91 W W TV- Pass F Fail r- Not Tested <br /> 9/10 87 W F-0 Wo Pass F Fail r- Not Tested <br /> 9/10 91 F%O- Wo R Pass r- Fail r- Not Tested <br /> 11/12 87 W Wo R Pass r Fail r- Not Tested <br /> 11/12 91 P-1 W F4/- Pass r- Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jarrod Cooke <br /> Signature: �� <br /> Environmental Compliance for Petroleum Systems <br /> ©2022 Tanknology Inc.,Austin,TX.All rights reserved. tanknology.com <br />