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aTanknology Impact Valve <br /> Inspection <br /> Impact Valve Operational <br /> Inspection <br /> Work Order: 2321576 Date: 2/12/2015 <br /> Site Name/ID: CHEVRON 209167 <br /> Address: 1234 E.YOSEMITE AVE 0 SPRECKLES <br /> City: MANTECA State: CA Zip: 95336 <br /> Dispenser Secure Valve <br /> Number Grade Mount? Lock? Pass/Fail Comments <br /> 1/2 87 R FF1 Pass Fail M Not Tested <br /> 1/2 91 R6 F-6 Pass Fail(17 Not Tested <br /> 3/4 87 R7 W G Passil Fail Not Tested <br /> 3/4 91 I F Q Pass M Fail Not Tested <br /> 5/6 87 FF R b k Pass G Fail M Not Tested <br /> 5/6 91 W Pass Fail ro Not Tested <br /> 7/8 87 RA F70 G Pass Fail rw Not Tested <br /> 7/8 91 P05 EF Pass Fail Not Tested <br /> 9/10 87 117-0 R G Pass ro Fail Not Tested <br /> 9/10 91 EF Pass Fail Not Tested <br /> 11/12 87 R 47 Passig Fail 0 Not Tested <br /> 11/12 91 R Pass Fail ; Not Tested <br /> Technician Comments: <br /> Technician Name: Gilbert Garcia <br /> Signature: i <br /> Environmental Compliance for Petroleum Systems <br /> ©2015 Tanknology Inc.,Austin,TX.All rights reserved.tanknology.com <br />