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Appondix IX <br /> Underground Storage Tank <br /> Owoiir ��till Prevention Equipment Inspection Repor � rorru , <br /> TYPE OF ACTION 7 Installation Test r' Repair Test r 36 Month Test <br /> 1 . FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 9/7/2021 <br /> Facility Name <br /> 7- ELEVEN 41187 <br /> Facility Address City Zip Code <br /> 1829 N Wilson Way Stockton 95204 <br /> 2 . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Tanknology , Inc. (800 ) 8004633 <br /> Mailing Address <br /> 11000 N . MoPac Suite 500 , Austin , Tx . 78759 <br /> Service Technician Performing Inspection <br /> Brent Bowen <br /> Contractor/Tank Tester License Number <br /> Class A General Engineering 743160 <br /> ICC Number Expiration Date <br /> 8211862 6/8/2023 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> ICC-CA UST Service Technician 8211862 06/08/2023 <br /> ICC- ICC UST Tank Tightness Testing ICC000217688 06/22/2023 <br /> OPW- EVR Phase 1 100255 01 /05/2022 <br /> 4 . INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedure Used Components Inspected <br /> Opw 71 so Drop tubes flappers <br /> 5 . CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> 1 hereby certify that the OPE was inspected in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637. 2; that required supporting <br /> documentation is attached; and all information contained herein is accurate. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 9/7/2021 2 <br /> CERS = California Environmental Reporting System , ID = Identification , ICC = International Code <br /> Council , OPE = Overfill Prevention Equipment <br />