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Appendix IX <br /> Underground Storage Tank <br /> Ove III Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ® 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10746523 12/13/2024 <br /> Facility Name <br /> Pershing Holdings Inc. <br /> Facility Address City ZIP Code <br /> 1329 Escalon Ave. Escalon 95320 <br /> 2. SERVICE TEC 4NICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Diamond Petroleum Services, Inc. (926) 470-0803 <br /> Mailing Address <br /> 3619 King Ct Anti Dch. CA 94509 <br /> Service Techniciar Performing Inspection <br /> Guadalupe Sanct ez <br /> Contractor/Tank Tester License Number <br /> 1005444 <br /> ICC Number Expiration Date <br /> 5250451 04/01/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder-Root ATC Technician #A30138 09/25/2025 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Proced res Used Components Inspected <br /> Veeder Root Overfill 87and 91 TLMs <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> I hereby certify tt,at 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 Date Total # of Pages <br /> "zz 12/13/2024 14 <br /> CERS = California nvironmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />