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4-AW Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2363183 Date: 12/13/2023 <br /> Site Name/ID: 7-ELEVEN#20632, MKT 2368 <br /> Address: 4627 DA VINCI DR @ MARCH LN <br /> City: STOCKTON State: CA Zip: 95207 <br /> How Inspected: Line Test r NFPA 30A r PEI RP1200R Other r <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 40 We r Pass r Fail r Not Tested <br /> 1/2 87 W r7l' P Pass r Fail r Not Tested <br /> 1/2 91 9- r Pass r Fail r Not Tested <br /> 3/4 40 FV- I✓ P Pass r Fail r Not Tested <br /> 3/4 87 W Wo r Pass r Fail r Not Tested <br /> 3/4 91 Fv- (✓ R Pass r Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jesus S�aldivar <br /> Signature: A, 4� <br /> Environmental Compliance for Petroleum Systems <br /> ©2024 Tanknology Inc.,Austin,TX.All rights reserved.tanknology.com <br />