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.� Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2358001 Date: 12/13/2022 <br /> Site Name/ID: 7-ELEVEN#20632, MKT 2368 <br /> Address: 4627 DA VINCI DR @ MARCH LN <br /> City: STOCKTON State: CA Zip: 95207 <br /> How Inspected: Line Test F NFPA 30A I- PEI RP1200 W Other F <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 40 W r Pass r- Fail F Not Tested <br /> 1/2 87 Wo R r Pass r- Fail r- Not Tested <br /> 1/2 91 Wo � r Pass r- Fail F Not Tested <br /> 3/4 40 I r Pass F Fail r- Not Tested <br /> 3/4 87 WO Pass r- Fail I- Not Tested <br /> 3/4 91 r Pass r Fail I- 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 />