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.-jp Tanknology <br />Work Order: <br />Site Name/ID <br />Address: <br />City: <br />Impact Valve <br />Inspection <br />Impact Valve Operational <br />Inspection <br />2353217 Date: 1/27/2022 <br />CHEVRON 208118 N-4087-1-3 <br />3355 E. HAMMER LANE @ HOLMAN RD <br />State: CA Zip: 95212 <br />How Inspected: Line Test F NFPA 30A r- PEI RP1200 W Other i - <br />Dispenser <br />Number <br />Grade <br />Secure <br />Mount? <br />Valve <br />Lock? <br />Pass/ Fail <br />Comments <br />1/2 <br />87 <br />rv- <br />Wo <br />ry-1 Pass r- Fail r- Not Tested <br />1/2 <br />91 <br />Wo <br />r <br />r Pass r- Fail F Not Tested <br />3/4 <br />87 <br />r <br />ry-, <br />r Pass r- Fail r Not Tested <br />3/4 <br />91 <br />+ <br />ry-1 <br />WO Pass r- Fail r- Not Tested <br />5/6 <br />87 <br />W <br />r <br />r Pass r Fail r Not Tested <br />5/6 <br />91 <br />Wo <br />r <br />ry-1 Pass r- Fail F Not Tested <br />7/8 <br />87 <br />P-1 <br />r <br />r Pass .F Fail r Not Tested <br />7/8 <br />91 <br />Wo <br />FI -1 <br />r Pass r- Fail r Not Tested <br />9/10 <br />87 <br />r <br />ry-1 <br />WO Pass F Fail F Not Tested <br />9/10 <br />91 <br />r <br />rv- <br />r Pass F Fail F Not Tested <br />11/12 <br />87 <br />r <br />ry-1 Pass F Fail F Not Tested <br />11/12 <br />91 <br />'+ <br />r <br />WO Pass F Fail F Not Tested <br />Technician Comments: <br />Technician Name: <br />Signature: <br />Jesus Saldivar <br />4 V 1 )'z1-- <br />Environmental Compliance for Petroleum Systems <br />©2022 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com <br />