Laserfiche WebLink
Appendix IX <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />TYPE OF ACTION r Installation Test r Repair Test P 36 Month Test <br />FACILITY INFORMATION <br />CERS ID <br />10165823 <br />Inspection Date <br />10/13/2023 <br />Facility Name <br />7-ELEVEN #17647, MKT 2368 (N-744) <br />Facility Address <br />1048 W. YOSEMITE AVE @ EL PORTEL <br />City <br />MANTECA <br />Zip Code <br />95336 <br />SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />Tanknology, Inc. <br />Phone <br />(800) 800-4633 <br />Mailing Address <br />11000 N. MoPac Suite 500, Austin, Tx. 78759 <br />Service Technician Performing Inspection <br />Jesus Saldivar <br />Contractor/Tank Tester License Number <br />Class A General Engineering 743160 <br />ICC Number <br />8361393 <br />Expiration Date <br />5/16/2025 <br />TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />OPW-EVR Phase 1 104302 01/04/2025 <br />INSPECTION PROCEDURES INFORMATION <br />Inspection Procedure Used Components Inspected <br />Industry Standards Droptube <br />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 />1v6- diL <br />Date <br />10/13/2023 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment