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Appendix IX PGE095 <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair 17136 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10148345 <br />Inspection Date <br />9/21/2022 <br />Facility Name <br />Pacific Gas and Electric Company <br />Facility Address <br />4040 West Ln. <br />City <br />Stockton <br />ZIP Code <br />95204 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />TAIT Environmental Services, Inc. <br />Phone <br />(714) 560-8222 <br />Mailing Address <br />11280 Trade Center Dr., Rancho Cordova, CA 95742 <br />Service Technician Performing Inspection <br />Jaime Jauregui <br />ontractor/Tank Tester License Number <br />F588098 <br />ICC Number <br />8340695 <br />Expiration Date <br />07-25-2024 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Veeder root - B48138 <br />09-07-2024 <br />4. INSPECTION PROCEDURES INFORMATION <br />Inspection Procedures Used <br />Components Inspected <br />PEI RP1200 <br />ATG Probe <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br />I 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 />Service Technician Signature <br />Date <br />9/21/2022 <br />Total # of Pages <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Page 1 of 2 <br />