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Appendix IX <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 />10181351 10/19/21 <br />Facility Name <br />Fast & Easy Gas Stockton <br />Facility Address <br />8660 N. Lower Sacramento Rd. <br />City <br />Stockton <br />ZIP Code <br />95210 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />Alltech Petro, Inc. <br />Phone <br />209-532-7320 <br />Mailing Address <br />P.O. Box 4208 Sonora CA 95370 <br />Service Technician Performing Inspection <br />Isaac Anderson <br />Contractor/Tank Tester License Number <br />CA 623541/09-1749 <br />ICC Number <br />8146912 <br />Expiration Date <br />09/10/22 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Veeder-Root Level IV #636878 <br />09/05/22 <br />OPW #100456 <br />05/11/22 <br />4. INSPECTION PROCEDURES INFORMATION <br />Inspection Procedures Used <br />Components Inspected <br />PEI RP -1200/ <br />87, 91, & Diesel Tanks <br />Manufacturer <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION <br />I 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 <br />Date <br />10/19/21 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Page 1 of 2 <br />