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1 <br /> HLUEIVED <br /> 4_i Tanknology Impact Valve <br /> Inspection MAY 15 .2:114 <br /> Impact Valve Operational jENVIR®NMENTA <br /> Inspection HEALTH DEPARTMENT <br /> Work Order: 2317840 Date: 4/23/2014 <br /> Site Name/ID: MARCH LANE 76 <br /> Address: 1206 E. MARCH LANE <br /> City: STOCKTON State: CA Zip: 95210 <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/ Fail Comments <br /> 1/2 87 W F%/_ (« Pass(- Fail C' Not Tested <br /> 1/2 91 W F7 r Pass(' Fail f Not Tested <br /> 3/4 87 F7 r (: Pass(- Fail C Not Tested <br /> 3/4 91 W I7o (a Pass(- Fail C Not Tested <br /> 5/ 87 7 f7v (*% Pass(% Fail t� Not Tested <br /> 5/ 91 F7 r Pass(- Fail Not Tested <br /> 6/ 87 r W G Pass(` Fail r Not Tested <br /> 6/ 91 F7 FV_ (+ Pass(' Fail( Not Tested <br /> 7/8 40 [70 (* Pass(' Fail(` Not Tested <br /> 7/8 87 r r (+ Pass(- Fail(` Not Tested <br /> 7/8 91 W Fv_0 (* Pass(- Fail(` Not Tested <br /> 9/10 40 117 I7 (* Pass(- Fail f Not Tested <br /> 9/10 87 W F7 t: Pass(' Fail(` Not Tested <br /> 9/10 91 F7 FV_ r Pass(% Fail C Not Tested <br /> Technician Comments: <br /> Technician Name: Timothy Elebeck <br /> Signature: <br /> Environmental Compliance for Petroleum Systems <br /> ©2014 Tanknology Inc.,Austin,TX. All rights reserved. tanknology.com <br />