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Appendix IX 202158 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION F-]Installation Repair F36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10181235 7/2/2025 <br /> Facility Name <br /> Arco 5450 <br /> Facility Address City ZIP Code <br /> 1617 W. Fremont Stockton 95203 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Kwestco LLC 925-551 7444 <br /> Mailing Address <br /> 5805 Sierra Court, Suite G, Dublin, CA 9456$ <br /> Service Technician Performing Inspection Gabriel Solori,o <br /> Contractorf rank Tester License Number <br /> 1073967 <br /> ICC Number Expiration Date <br /> 10425282 <br /> 9/14/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> DPW [1ST EVR Phase 1 Tech Cert #1193597 6/9/2027 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Tank Chart/Tape measure Flapper Valves <br /> a. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> !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 supporfing <br /> documentation is attached; and all information contained herein is accurate. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total#of Pages <br /> 7/2/2025 2 <br /> CERS = California Environmenta eporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention quipment <br /> Page 1 of 2 <br />