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Impact Valve <br /> .LAP Tanknology Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2363810 Date: 1/8/2024 <br /> Site Name/ID: CHEVRON 208118 N-4087-1-3 <br /> Address: 3355 E. HAMMER LANE @ HOLMAN RD <br /> City: STOCKTON State: CA Zip: 95212 <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 FV- Wo ry-1 Pass r- Fail I- Not Tested <br /> 1/2 91 Wo r r Pass r- Fail F Not Tested <br /> 3/4 87 r FI-1 r Pass r- Fail r Not Tested <br /> 3/4 91 + ry-1 Fv-1 Pass r- Fail r- Not Tested <br /> 5/6 87 W r r Pass r Fail r Not Tested <br /> 5/6 91 Wo 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 FI-1 r Pass r- Fail r Not Tested <br /> 9/10 87 r ry-1 WO Pass F Fail F Not Tested <br /> 9/10 91 r rv- r Pass F Fail F Not Tested <br /> 11/12 87 r ry-1 Pass F Fail F Not Tested <br /> 11/12 91 '+ r Fv-1 Pass F Fail F Not Tested <br /> Technician Comments: <br /> Technician Name: Jess/us Saldivar A <br /> Signature: )'z1-- <br /> Environmental <br /> '.-Environmental Compliance for Petroleum Systems <br /> ©2024 Tanknology Inc.,Austin, TX.All rights reserved. tanknology.com <br />