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Tanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2330296 Date: 3/24/2017 <br /> Site Name/ID: CHEVRON 307709 <br /> Address: 10858 TRINITY PKWY <br /> City: STOCKTON State: CA Zip: 95219 <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 W P Pass r Fail t' Not Tested <br /> 1/2 91 P P Pass Fail Not Tested <br /> 3/4 55 W W Pass (- Fail Not Tested <br /> 3/4 87 W W Pass r Fail Not Tested <br /> 3/4 91 F%W W Pass (- Fail t Not Tested <br /> 5/6 87 W (w Pass r' Fail Not Tested <br /> 5/6 91 [✓ W Pass (- Fail r Not Tested <br /> 7/8 87 WV W f: Pass(- Fail C Not Tested <br /> 7/8 91 FV- W Pass (- Fail Not Tested <br /> 9/10 87 W W Pass (- Fail Not Tested <br /> 9/10 91 W Wo C Pass f Fail Not Tested <br /> 11/12 55 Wo W (: Pass r Fail Not Tested <br /> 11/12 87 W W Pass < Fail Not Tested <br /> 11/12 91 W r✓ Pass (- Fail <' Not Tested <br /> Technician Comments: <br /> Technician Name: Steve Wil1le�ms <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2017 Tanknology Inc., Austin, TX.All rights reserved. tanknology.com <br />