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CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Page 1 of 2 <br />TYPE OF ACTION Installation Repair 36 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10187387 <br />Inspection Date <br />8-14-24 <br />Facility Name <br />United Pacific #5267 <br />Facility Address <br />1137 W. Lathrop <br />City <br />Manteca <br />ZIP Code <br />95337 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />CGRS, Inc. <br />Phone <br />(916) 991-1100 <br />Mailing Address <br />5444 Dry Creek Road; Sacramento, CA. 95838 <br />Service Technician Performing Inspection <br />Garrett Warren <br />Contractor/Tank Tester License Number <br />CSLB#803616 <br />ICC Number <br />8185019 <br />Expiration Date <br />12-19-24 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />OPW UST EVR Phase 1 Cert# 101018 5 27 25 <br />Franklin Fueling Phase 1 EVR UST Cert.#1000553709 11 24 25 <br />4. INSPECTION PROCEDURES INFORMATION <br />Inspection Procedures Used Components Inspected <br />RP-Overfill Valve / Drop Tubes <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br />I 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 <br />Garrett Warren <br />Date <br />8-14-24 <br />Total # of Pages