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4-JWTanknologyImpact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2359214 Date: 3/8/2023 <br /> Site Name/ID: 7-ELEVEN#32262, MKT 2368(N-3940-1 <br /> Address: 2360 W GRANTLINE I-205 OFF RAMP <br /> City: TRACY State: CA Zip: 95376 <br /> How Inspected: Line Test r NFPA 30A F- PEI RP1200 r Other r- <br /> Dispenser Secure I Valve <br /> Number Grade I Mount? Lock? I Pass/ Fail Comments <br /> 1/2 87 W Io ry-1 Pass r- Fail r- Not Tested <br /> 1/2 89 FV- 9 r Pass r Fail r- Not Tested <br /> 1/2 91 W r FO Pass r' Fail F Not Tested <br /> 3/4 87 ryF r Pass r- Fail r Not Tested <br /> 3/4 89 iv r Pass r Fail r Not Tested <br /> 3/4 91 ryr RO Pass F Fail r Not Tested <br /> 5/6 87 iv R P Pass r- Fail r- Not Tested <br /> 5/6 89 iv R r Pass r- Fail r- Not Tested <br /> 5/6 91 ry 90 rV Pass r Fail r Not Tested <br /> 7/8 87 FV- r r Pass F Fail F Not Tested <br /> 7/8 89 ryW WO Pass F- Fail r Not Tested <br /> 7/8 91 W W R Pass F Fail r Not Tested <br /> 9/10 87 FV- 90 PO Pass r- Fail r- Not Tested <br /> 9/10 89 W r r Pass r- Fail r- Not Tested <br /> 9/10 91 id WO )O Pass r Fail F Not Tested <br /> 11/12 87 W 'V- WO Pass r Fail r- Not Tested <br /> 11/12 89 W W r Pass r Fail r Not Tested <br /> 11/12 91 W WO Pass r- Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Clint <br /> F�uhrman <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2023 Tanknology Inc.,Austin,TX.All rights reserved. tanknology.com <br />