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UNDERGROUND STORAGE TANK OVERFILL PREVENTION EQUIPMENT INSPECTION REPORT FORM (Page 1 of 1) Type of Action ❑ Installation Inspection ❑ Repair Inspection ❑x 36 Month Inspection I. FACILITY INFORMATION CERS ID Date of Overfill Prevention Equipment Inspection 10169781 10/5/2018 Business Name (Same as Facility Name or DBA-Doing Business As) Colonial Energy #40134 Business Site Address City ZIP Code 1434 W. Yosemite Ave I Manteca 95337 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Inspection (Print as shown on the ICC Certification.) Phone # Nicholas C Janoe (916) 373-1166 Contractor I Tank Tester License # ICC Certification # ICC Certification Expiration Date 617238 8712764 4/11/2019 Overfill Prevention Equipment Inspection Training and Certifications (List applicable certifications.) OPW III. OVERFILL PREVENTION EQUIPMENT INSPECTION I O Inspection Method ❑x Manufacturer Guidelines (Specify): Used: OPW Install & Maintenance Guidelines DEC 0 5 2018 ❑ Industry Code or Engineering Standard (Specify): ❑ Engineered Method (Specify): ENVIRONVIEN IAL HEAM- QFPA-I N Attach the inspection procedures and all documentation required to determine the results. = of Attached Pages TANK ID: (By tank number, stored product, etc.) 87 Gasoline 91 Gasoline Diesel What is the tank inside diameter? (Inches) 95 3/4" 95 3/4" 95 3/4" Is the fill piping secondarily contained? ❑ Yesx❑ No ❑ Yes 0 No ❑ Yes Z No ❑ Yes ❑ No Is the vent piping secondarily contained? ❑ Yes I] No ❑ Yes ❑x No ❑ Yes El No ❑ Yes ❑ No Overfill Prevention Equipment Manufacturer(s) OPW oPw OPW What is the overfill prevention equipment response ❑ Shuts Off Flow ❑ Shuts Off Flow ❑ Shuts Off Flow ❑ Shuts Off Flow when activateda (Check all that apply) ❑x Restricts Flow ZRestricts Flow ZRestricts Flow ElRestricts Flow ❑ AN Alarm ❑ AN Alarm ❑ AN Alarm ❑ AN Alarm Are flow restrictors installed on vent piping? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No At what level in the tank is the overfill prevention set 86 3/8" 86 3/8" to activate? (Inches from bottom of tank.) What is the percent capacity of the tank at which the 95% 95% overfill prevention equipment activates? Is the overfill prevention in proper operating condition ❑x Yes ❑x Yes ❑ Yes ❑ Yes to respond when the substance reaches the appropriate level? ❑ No (Specify in V) ❑ No (Specify in V.) ❑ No (Specify in V) ❑ No (Specify in V) IV. SUMMARY OF INSPECTION RESULTS Overfill Prevention Inspection Results TF—Z—Pass ❑ Fail 0 Pass ❑ Fail 11 ❑ Pass ❑x Fail ❑Pass ❑ Fail V. COMMENTS Any items marked "Fail' must be explained in this section. Any additional comments may also be provided here. Unable to inspect the diesel drop tube due to the nipple and spill container being seized together. The bottom of the spill container was turning while trying to loosen the nipple. V1. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS INSPECTION I hereby certify that the overfill prevention equipmentwas inspected in accordance with California Code of Regulations, Title 23, Division 3, Chapter 16, Section 2637.2 and all the information contained herein is accurate. UST Service Technician Signature l ga4-e4& If the facility has more components than this form accomrrt6dates, additional copies of this page may be attached. CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council, AA/ = Audible and Usual