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Tanknology Impact Valve <br />Inspection <br />Work Order: <br />Site Name/ID: <br />Address: <br />City: <br />Impact Valve Operational <br />Inspection <br />2334431 <br />CHEVRON 307709 <br />10858 TRINITY PKWY <br />STOCKTON <br />Date: 3/20/2018 <br />State: CA <br />Zip: 95219 <br />Dispenser <br />Number <br />Grade <br />Secure <br />Mount? <br />Valve <br />Lock? <br />Pass/ Fail <br />Comments <br />1/2 <br />87 <br />W <br />I70 <br />is Pass r Fail r Not Tested <br />1/2 <br />91 <br />W <br />(āœ“ <br />I: Pass r Fail r Not Tested <br />3/4 <br />55 <br />r <br />W <br />!: Pass r Fail r Not Tested <br />3/4 <br />87 <br />57 <br />W <br />r: Pass r Fail r Not Tested <br />3/4 <br />91 <br />W <br />r <br />t+ Pass r` Fail r Not Tested <br />5/6 <br />87 <br />rV-0 <br />170 <br />r+` Pass r' Fail f Not Tested <br />5/6 <br />91 <br />W <br />w <br />ro Pass r Fail r Not Tested <br />7/8 <br />87 <br />I, <br />iāœ“ <br />i+ Pass r Fail r Not Tested <br />7/8 <br />91 <br />W <br />r <br />f: Pass r Fail r Not Tested <br />9/10 <br />87 <br />W <br />W <br />r Pass r Fail r Not Tested <br />9/10 <br />91 <br />r <br />R <br />G Pass f Fail r Not Tested <br />11/12 <br />55 <br />W <br />Pā€” <br />f: Pass f Fail r Not Tested <br />11/12 <br />87 <br />W <br />rv-1 <br />r: Pass r` Fail i Not Tested <br />11/12 <br />91 <br />r <br />F7 <br />I: Pass r Fail r' Not Tested <br />Technician Comments: <br />Technician Name: <br />Signature: <br />Jarrod Cooke <br />Environmental Compliance for Petroleum Systems <br />©2018 Tanknology Inc., Austin, TX. All rights reserved. tanknology.com <br />