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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 <br /> CERS ID 10184311 Inspection Date <br /> 03-14-2024 <br /> Facility Name MARATHON GAS <br /> Facility Address cityS CENTER ST C�ty ZIP Code <br /> STOCKTON <br /> 95203 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> ECO-CHEK COMPLINCE,INC. 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 Number08-1740 Ex.3/31 /26 <br /> ICC Number Expiration Date <br /> 8883072_UT 11/11/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Veeder Root B34976 7/5/2024 <br /> Incon 1009883708 12/11/2024 <br /> VM 1 2517 11/8/2025 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> OPW FLAPPERS <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 Tam Date Total # of Pages <br /> 03-14-2024 6 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />