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.� Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2356001 Date: 7/7/2022 <br /> Site Name/ID: 7-ELEVEN#17647, MKT 2368 (N-744) <br /> Address: 1048 W.YOSEMITE AVE @ EL PORTEL <br /> City: MANTECA State: CA Zip: 95336 <br /> How Inspected: Line Test F NFPA 30A I— PEI RP1200 W Other (— <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 W r Pass r— Fail F Not Tested <br /> 1/2 91 Wo R r Pass r— Fail F Not Tested <br /> 3/4 87 Wo � r Pass 7 Fail F Not Tested <br /> 3/4 91 I- r Pass F Fail F Not Tested <br /> Technician Comments: <br /> Technician Name: Clint <br /> F�uhrman <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2022 Tanknology Inc.,Austin, TX.All rights reserved.tanknology.com <br />