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Appendix IX 205632 <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />TYPE OF ACTION Installation . FIRepair 736 Month <br />1. FACILITY INFORMATION <br />CERS 1D <br />10977436 <br />Inspection Date <br />5/13/2025 <br />Facility Name <br />Arco 7193 <br />Facility Address <br />9636 Thornton Rd. <br />City <br />Stockton <br />ZIP Code <br />95209 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />Nwestco LLC <br />Phone <br />925-551-7444 <br />Mailing Address <br />6805 Sierra Court, Suite G, 17ublin, CA 94568 <br />Service Technician Performing Inspection <br />Robert Jacobs <br />ContractorlTank Tester License Number <br />1073967 <br />ICC Number <br />8819943 <br />Expiration Date <br />8/31/2026 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />OPW UST EVR Phase 1 Tech Cent #0177621 <br />1/4/2427 <br />4. INSPECTION PROCEDURES INFORMATION <br />inspection Procedures Used <br />Components Inspected <br />Tank Charts/Tape Measure <br />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. 1 understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature <br />h--� <br />Date <br />6/11/2025 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, 1D = identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Page 1 of 2 <br />