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Appendix IX 198071 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION FlInstallation Repair Fv(]36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10180735 4/8/2025 <br /> Facility Name <br /> Arco 7161 <br /> Facility Address City ZIP Code <br /> 1243 West March Lane Stockton 95207 <br /> 2.` SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Nwestco LLC 925-551-7444 <br /> Mailing Address <br /> 6805 Sierra Court, Suite G, Dublin, CA 94568 <br /> Service Technician Performing Inspection Jaycee cornett <br /> Contractor/Tank Tester License Number <br /> 1073967 <br /> ICC Number Expiration Date <br /> 10421744 <br /> 8/16/2026 <br /> 3.`' TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW UST EVR Phase 1 Tech Cert #1193838 2/1/2026 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Tank Chart/Tape Measure Flapper Valves <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 Date Total# of Pages <br /> 4/8/2025 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> __ __ Page_1_of 2 <br />