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� Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2387486 Date: 2/4/2026 <br /> Site Name/ID: CHEVRON 209167 <br /> Address: 1234 E.YOSEMITE AVE @ SPRECKLES <br /> City: MANTECA State: CA Zip: 95336 <br /> How Inspected: Line Test r NFPA 30A r- PEI RP1200 r Other F- <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 r Wo WO Pass F- Fail 17- Not Tested <br /> 112 91 l P-1 r Pass F- Fail r- Not Tested <br /> 3/4 87 W P Pass f- Fail r- Not Tested <br /> 3/4 91 r W WO Pass r Fail r- Not Tested <br /> 5/6 87 FV Fv-' WO Pass r Fail r Not Tested <br /> 5/6 91 TV- r P Pass r- Fail r- Not Tested <br /> 7/8 87 W W r Pass F- Fail 17- Not Tested <br /> 7/8 91 rV Pass r- Fail r- Not Tested <br /> 9/10 87 r P Pass r Fail r- Not Tested <br /> 9/10 91 ry FV r Pass r Fail r Not Tested <br /> 11/12 87 '+ r WO Pass r Fail r- Not Tested <br /> 11/12 91 W Pass r- Fail r Not Tested <br /> Technician Comments: <br /> Technician Name: Jesus Saldivar <br /> Signature: // JIB-- <br /> Environmental Compliance for Petroleum Systems <br /> @2026 Tanknology Inc.,Austin,TX.All rights reserved.tanknology.com <br />