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Appendix IX <br /> Underground Storage Wank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑Installation ❑Repair 036 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10181299 03/04/2025 <br /> Facility Name <br /> California Stop <br /> Facility Address City ZIP Code <br /> 2224 S Mathey RD I Stockton, CA 95206 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> MB Services (707) 439-3778 <br /> Mailing Address <br /> P.O. BOX. 1299 Suisun City, CA 94585 <br /> Service Technician Performing Inspection <br /> Brian Dunahay <br /> Contractor/Tank Tester License Number <br /> 945643 <br /> ICC Number Expiration Date <br /> 8021436 05/23/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW 0177221 03/25/2026 <br /> RP1200 <br /> 4. INSPECTIONPROCEDURES INFORMATION <br /> InspectionProcedures Used Components Inspected <br /> Manufacture Drope Tubes <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> 1 hereby certify that the OPE was inspected in accordance with California Code of Regulations, title <br /> 23, division 3, chapter 16, section 2637.2; that required suppDrzing documentation is attached, and all <br /> information contained herein is accurate. I understand that test procedures shall be made available <br /> upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 2 <br /> 03/04/2025 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />