Laserfiche WebLink
May, 5, 2021 11 : 18AM Donlee Pump C'. No, 5333 F'. 2 <br /> Appendix IK <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair 0 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID _ Inspection Date <br /> 4/29/21 <br /> Facility Name <br /> Statewide Petroleum <br /> Facility Address City ZIP Code <br /> 1700 E. Yosemite Ave. Manteca 94566 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> Donlee Pump Company (209) 537-9396 <br /> Mailing Address <br /> 2825 Railroad Ave, Ceres, CA, 95307 <br /> Service Technician Performing Inspection <br /> Alex Brambll <br /> Contractor/Tank Tester License Number <br /> ICC Number Expiration Date <br /> 8881772 2/23/23 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> M6Nv1'+1 6v LAS $7 o'/r'4zuxtL vitt-'VF. C'A veQ) <br /> S. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br /> l hereby certify that the OPE was inspected in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 96, 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 /> Servi e Technician Signature Date Total 4 of Pages <br /> CER S = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br />