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Appendix IX 210209-621 <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ✓❑ 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10403278 03/02/21 <br /> Facility Name <br /> Lodi CA FO Term (Intl) <br /> Facility Address City ZIP Code <br /> 2500 West Turner Road Lodi 95242 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> SunWest Engineering Constructors, Inc. (888)588-8737 <br /> Mailinq Address <br /> 4780 Cheyenne Way, Chino, CA 91710 <br /> Service Technician Performing Inspection <br /> Kraig Kinder <br /> Contractor/Tank Tester License Number <br /> CA-703190 <br /> ICC Number Expiration Date <br /> 8296393 11/18/22 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW 6/26/21 <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected <br /> Industry Code PEI-RP-1200-12 <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 /> Digitally signori by Kraig Kindor <br /> Kraig Kinder-06too202103.02,,5606 03/02/21 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> QA/QC APPROVED <br /> 3/16/20219:24 AMTara Neig Page 1 of 2 <br />