Laserfiche WebLink
Appendix IX <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />TYPE OF ACTION I i Installation Test r Repair Test r 36 Month Test <br />1. FACILITY INFORMATION <br />CERS ID <br />10184299 <br />Inspection Date <br />2/29/2024 <br />Facility Name <br />CHEVRON 209167 <br />Facility Address <br />1234 E. YOSEMITE AVE @ SPRECKLES <br />City <br />MANTECA <br />=9'p5 <br />6 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Inspection <br />Inc. <br />=PhoneTanknology, <br />0-4633 <br />Mailing Address <br />11000 N. MoPac Suite 500, Austin, Tx. 78759 <br />Service Technician Performing Inspection <br />Jesus Saldivar <br />ContractorlTank Tester License Number <br />Class A General Engineering 743160 <br />ICC Number j:E=xpiration5Date8361393 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />OPW-EVR Phase 1 104302 <br />01/04/2025 <br />4. INSPECTION PROCEDURES INFORMATION <br />Used <br />STANDARDS <br />Components Inspected <br />DROP TUBE <br />tInspectionProcedure <br />5. CERTIFICATION BY SERVICE <br />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 />ServiceTechnician Signature <br />44� <br />Date <br />2/29/2024 <br />Total # of Pages <br />2 <br />CERS =California Environmental Reporting System, ID =Identification, ICC =International Code <br />Council, OPE =Overfill Prevention Equipment <br />