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,Lip Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2367523 Date: 6/11/2024 <br /> Site Name/ID: 7-ELEVEN 41216 <br /> Address: 770 W. Charter Way <br /> City: Stockton State: CA Zip: 95206 <br /> How Inspected: Line Test F NFPA 30A F PEI RP1200 W Other F <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 Wo Wo F7 Pass r- Fail r Not Tested <br /> 112 91 F70 F7 W Pass r- Fail r- Not Tested <br /> 3/4 40 r F7 W Pass r- Fail F Not Tested <br /> 3/4 87 iW F-0 FY-1 Pass r- Fail r- Not Tested <br /> 3/4 91 F%O- Wo W Pass r- Fail r- Not Tested <br /> 5/6 87 W W W Pass r- Fail r- Not Tested <br /> 5/6 91 P-1 W W Pass F Fail ,F Not Tested <br /> 7/8 87 W W R Pass F Fail r- Not Tested <br /> 7/8 91 W F-0 F� Pass F Fail r- Not Tested <br /> 9/10 87 F%O- Wo R Pass r- Fail r- Not Tested <br /> 9/10 91 W Wo W Pass r Fail r- Not Tested <br /> 11/12 40 P-1 W W Pass r- Fail r Not Tested <br /> 11/12 87 W W rv- Pass F Fail F Not Tested <br /> 11/12 91 FV- Wo F� Pass r- Fail r- Not Tested <br /> Technician Comments: <br /> Technician Name: Jesus Saldivar <br /> Signature: '4 dzl�- <br /> Environmental Compliance for Petroleum Systems <br /> ©2024 Tanknology Inc.,Austin,TX.All rights reserved. tanknology.com <br />