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Impact Valve <br /> 4-AW Tanknology Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2350909 Date: 7/28/2021 <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 r- NFPA 30A F PEI RP1200r- Other r- <br /> DispenserSecure Valve <br /> NumberF87 <br /> Mount? Lock? Pass/ Fail Comments <br /> 1/2 F F F Pass r Fail r- Not Tested <br /> 1/2 91 F7 F P-1 Pass r- Fail r- Not Tested <br /> 3/4 87 R F F Pass r Fail r- Not Tested <br /> 3/4 91 F F F Pass r- Fail r- Not Tested <br /> Technician Comments: <br /> Technician Name: Tim Elebeck <br /> Signature: ` E-LA 'k <br /> Environmental Compliance for Petroleum Systems <br /> ©2021 Tanknology Inc.,Austin,TX.All rights reserved. tanknology.com <br />