Laserfiche WebLink
�- Appendix IX <br />Underground Storage Tank -yam <br />Overfill Prevention Equipment Inspection Report Form �© <br />TYPE OF ACTION ❑ Installation ❑ Repair ❑ 36 Month <br />1. FACILITY INFORMATION <br />CERS ID 10182307 <br />Inspection Date <br />5/18/2021 <br />Facility NameQUICKIKLEEN CAR WASH <br />Facility Address 707 E YOSEMITE AVE <br />cityMANTECA <br />ZIP Code <br />95336 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the InspectionAFFORDATEST <br />Phone <br />209-744-0112 <br />Mailing Address 416 2ND STREET GALT, CA 95632 <br />Service Technician Performing Inspection EDWARD STEARNS <br />Contractor/Tank Tester License Number 14-1760 Ex. 09/30/2023 <br />ICC Number 8883080 -UT <br />Expiration Date <br />1116/2022 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />FF- EBW , Phil-Tite & EVR Phase 1 1009893708 Ex 11/28/2022 <br />Emco 3205 Ex. 02/24/2023 ATG: VR A31048 Ex.7/31/2021 Incon 1009893708 3/1/2023 <br />OPW 104-635 Ex 3-12-2022 <br />4. INSPECTION PROCEDURES INFORMATION <br />Inspection Procedures Used <br />Components Inspected <br />MANUFACTURER <br />OVERFILL VALVE <br />5. CERTIFICATION BY SERVICE <br />TECHNICIAN CONDUCTING INSPECTION <br />1 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 />Rarvira Tarhnirinn Rinnn itra _ _. <br />L` <br />Date <br />5/18/2021 <br />Total # of Pages <br />4 <br />--- CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />