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Impact Valve <br /> .LAP Tanknology Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2358557 Date: 2/2/2023 <br /> Site Name/ID: CHEVRON #208117 <br /> Address: 755 S.TRACY BLVD <br /> City: TRACY State: CA Zip: 95376 <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 F IO Pass r— Fail F Not Tested <br /> 1/2 91 Wo rv- r Pass r— Fail F Not Tested <br /> 3/4 87 Io W r Pass r- Fail r Not Tested <br /> 3/4 91 IV7 FY-1 WO Pass r- Fail r- Not Tested <br /> 5/6 87 Io W r Pass r Fail r Not Tested <br /> 5/6 91 I r ry-1 Pass r- Fail F Not Tested <br /> 7/8 87 P-1 r r Pass .F Fail r Not Tested <br /> 7/8 91 Wo r r Pass r— Fail r Not Tested <br /> 9/10 87 P-1 FY-1 WO Pass F Fail F Not Tested <br /> 9/10 91 Io FV r Pass F Fail F Not Tested <br /> 11/12 87 Y FY-1 Pass F Fail F Not Tested <br /> 11/12 91 Y FYI WO Pass F Fail F Not Tested <br /> Technician Comments: <br /> Technician Name: Landon Zamora <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2023 Tanknology Inc.,Austin, TX.All rights reserved. tanknology.com <br />