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.-jw Tanknology <br />Work Order: <br />Site Name/ID <br />Address: <br />City: <br />How Inspected <br />2358565 <br />Chevron 372736 <br />9484 West Lane <br />Stockton <br />Impact Valve <br />Inspection <br />Impact Valve Operational <br />Inspection <br />Date: 2/13/2023 <br />State: CA <br />Line Test r NFPA 30A F PEI RP1200 r <br />Other F <br />Zip: 95210 <br />Dispenser <br />Number <br />Grade <br />Secure IValve <br />I Mount? <br />Lock? <br />I Pass/ Fail <br />Comments <br />1/2 <br />40 <br />W <br />Io <br />FY -1 Pass F Fail F Not Tested <br />1/2 <br />87 <br />ry <br />9 <br />r Pass r Fail r- Not Tested <br />1/2 <br />91 <br />W <br />r <br />FO Pass r' Fail F Not Tested <br />3/4 <br />40 <br />ry <br />F <br />r Pass r- Fail r Not Tested <br />3/4 <br />87 <br />iv <br />FV <br />W Pass r Fail r Not Tested <br />3/4 <br />91 <br />ry <br />r <br />WO Pass F Fail r Not Tested <br />5/6 <br />40 <br />iv <br />W <br />P Pass r- Fail r- Not Tested <br />5/6 <br />87 <br />W <br />rv- <br />r Pass r- Fail r- Not Tested <br />5/6 <br />91 <br />iv <br />90 <br />R Pass r Fail r Not Tested <br />7/8 <br />40 <br />W <br />r <br />r Pass F Fail F Not Tested <br />7/8 <br />87 <br />ry <br />W <br />WO Pass F- Fail r Not Tested <br />7/8 <br />91 <br />ry <br />W <br />it Pass F Fail r Not Tested <br />9/10 <br />40 <br />iv <br />90 <br />r Pass r- Fail r- Not Tested <br />9/10 <br />87 <br />W <br />r <br />r Pass r- Fail r- Not Tested <br />9/10 <br />91 <br />id <br />WO <br />)O Pass r Fail F Not Tested <br />11/12 <br />40 <br />W <br />'V- <br />WO Pass r Fail Not Tested <br />11/12 <br />87 <br />ry <br />W <br />WO Pass r Fail r Not Tested <br />11/12 <br />91 <br />W <br />WO Pass r- Fail r Not Tested <br />Technician Comments: <br />Technician Name: Jesus Saldivar <br />Signature: // 14�- <br />Environmental Compliance for Petroleum Systems <br />©2023 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com <br />