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TYPE OF ACTION □ Installation □ Repair □ 36 Month <br />10830655 <br />Facility Name CHEROKEE ARCO <br />Expiration Date <br />Emco #3207 Ex. 2/24/25 ATG: VR: B34975 ATG: 2/8/24 INCON 1009853708 Ex.11/11/24 <br />Components Inspected <br />FLAPPERS <br />.^anzino Taahniz'ian .Qinnatiira <br />Page 1 of 2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council, OPE = Overfill Prevention Equipment <br />Appendix IX <br />Underground Storage Tank <br />Overfill Prevention Equipment Inspection Report Form <br />Total # of Pages <br />2 <br />ZIP Code <br />95205 <br />1. FACILITY INFORMATION <br />CERS ID <br />3. TRAINING AND CERTIFICATIONS_______________________ <br />Manufacturer and Test Equipment Training Certifications <br />FF- EBW , Phil-Tite & EVR Phase 1 1009853708 Ex 11/29/24 <br />QPW 104-633 Ex 3-13-24 <br />4. INSPECTION PROCEDURES INFORMATION <br />Inspection Procedures Used <br />OPW <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING INSPECTION______________ <br />/ 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 />Date <br />12/20/23 <br />Phone <br />209-744-0112 <br />Facility Address3443 CHER0KEE RD CltySTOCKTON <br />ICC Number 8883059-UT <br />Inspection Date <br />12/20/23 <br />Expiration Date <br />01/30/24 <br />2. SERVICE TECHNICIAN INFORMATION__________ <br />Company Performing the Inspection .AffordaTest <br />Mailing Address41g Qa|t CA <br />Service Technician Performing Inspection J Winklei* <br />Contractor/Tank Tester License Numbe/Qg /39 Ex 2/28/26