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Appendix IX <br /> Underground Storage Tank <br /> Overfill Prevention Equipment Inspection Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair M 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Inspection Date <br /> 10399867 7/21/22 <br /> Facility Name <br /> Hunt & Sons Arch Rd. Cardlock <br /> Facility Address City ZIP Code <br /> 4733 S, Hwy 99 Frontage Rd. Stockton 95205 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Inspection Phone <br /> t <br /> Donlee Pump Company 209-537-9396 1 <br /> Mailing Address <br /> 2825 Railroad Ave. Ceres CA. 95307 <br /> Service Technician Performing Inspection <br /> Gerardo Perez <br /> Contractor/Tank Tester License Number <br /> 432089 <br /> ICC Number Expiration Date <br /> 8962656 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Emco Wheaton 5/31/21 <br /> OPW 8/26/22 <br /> i <br /> i <br /> i <br /> i <br /> 4. INSPECTION PROCEDURES INFORMATION <br /> Inspection Procedures Used Components Inspected j <br /> Manufacturer Spec. <br /> i <br /> s <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 i <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Tec ician S' ure Date Total #of Pages <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council, OPE = Overfill Prevention Equipment <br /> Page 1 of 2 <br /> s <br />