Laserfiche WebLink
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 <br />CERS ID 10184731 Inspection Date <br />05-30-2024 <br />Facility Name <br />Nashir EI Dorado Inc <br />Facility Address 713 EL DORADO City STOCKTON ZIP Code <br />95204 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />ECO-CHEK COMPLINCE,INC. <br />Phone <br />888-500-CHEK <br />Mailing Address P.O. BOX 1394 LAFAYETTE, CA 94549 <br />Service Technician Performing Inspection Felix Ramirez <br />Contractor/Tank Tester License Number 08-1740 Ex. 05/31/2026 <br />ICC Number <br />8883072 -UT <br />Expiration Date <br />11/11/2024 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />FF- FF- EBW , Phil-Tite & EVR Phase 1 1009883708 EX 12/28/24 <br />12/28/2024 <br />Emco 3147 Ex. 02/24/25 VR: B34976 ATG: 7/08/2024 Incon 1009883708 Ex 12/11/24 <br />OPW 104-634 Ex 3/10/2026 <br />03/10/2026 <br />4. INSPECTION PROCEDURES INFORMATION <br />Inspection Procedures Used Components Inspected <br />OPW FLAPPER <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br />1 hereby certify that 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. I understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature Fe � �Ll/ ,' a� <br />Date <br />05-30-2024 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Page 1 of 2 <br />