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Appendix IX <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ® 36 Month <br /> 1. FACILITY INFORMATION 7-71 <br /> CERS ID Inspection Date <br /> 10761034 04/19/2024 <br /> Facility Name <br /> ARCO AM/PM # 8 831 <br /> Facility Address City ZIP Code <br /> 1904 Daniels St Manteca 95337 <br /> 2. SERVICE TEC NICIAN INFORMATION <br /> Company Perform ng the Inspection Phone <br /> Diamond Petroleum Services, Inc. (925) 470-0803 <br /> Mailing Address <br /> 3619 Kinq Ct Antioch, CA 94509 <br /> Service Technician Performing Inspection <br /> Guadalupe Sanchez <br /> Contractor/Tank Tester License Number <br /> 1005444 <br /> [CC Number Expiration Date <br /> 5250451 04/01/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Fest Equipment Training Certifications Expiration Date <br /> OPW Phase I US EVR Tech # 0163755 06/06/2025 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> OPW 71 SO Work sheet 87, 91 and Diesel Drop Tubes <br /> 5. CERTIFICATIC N BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> I hereby certify it, t the OPE was inspected in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.2; that required supporting <br /> documentation is attached; and all information contained herein is accurate. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Techniciar Signature Date Total # of Pages <br /> 04119/2024 15 <br /> CERS = California Environm tal Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Ov rfill Prevention Equipment <br /> Page 1 of 2 <br />