Laserfiche WebLink
s <br />REED <br />SEP 222016 <br />1. FACILITY INFORMATION ENVIRONMENTAL HEALTH <br />Facility Name: Rancho San Miguel Market Date of Testing: CERARTM ENT !� <br />Facility Address: 1409 S. Airport Way, Stockton CA 95206 <br />Facility Contact: Phone: (209) 942-2840 <br />Date Local Agency Was Notified of Testing; 8/9116 SB989 — 3yr. Compliance Test <br />Name of Local Agency Inspector (if present during testing): <br />2. TF.STiNC CONTRACTOR INFORMATION <br />Company Name: ABLE Maintenance, Inc. <br />Technician Conducting Test: James Moore / I.C.C. #5254517 -UT <br />Credentials: ® CSLB Licensed Contractor E S WRCB Licensed Tank Tester <br />License Type: A, B, Haz., C10 license Number: 312844- <br />—, i <br />Manufacturer Training <br />Manufacturer Component(s) Date Training Ex ires <br />Available upon request <br />3. SUMMARY OF TEST RESULTS <br />Component: Pass Fail Not Repairs Component: Pass Fail Not Repairs <br />Tested Made Tested Made <br />87/91 Tank Annular D <br />❑ <br />❑ <br />❑ <br />87 Secondary Product © <br />❑ <br />❑ <br />❑ <br />91 Secondary Product D <br />❑ <br />❑ <br />❑ <br />Vent Secondary Product ® <br />❑ <br />❑ <br />❑ <br />Vapor Secondary Product © <br />❑ <br />❑ <br />❑ <br />i 87 Turbine Sump El <br />❑ <br />❑ <br />❑ <br />91 Turbine Sump El <br />❑ <br />❑ <br />❑ <br />UDC 1/2 17 <br />❑ <br />❑ <br />❑ <br />UDC 3/4 100 <br />❑ <br />11UDC <br />5/6 © <br />❑ <br />❑ <br />El <br />87 Fill Sump © <br />❑ <br />El❑ <br />9117ill Sump ® <br />❑ <br />❑## <br />❑ <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Used pump test truck <br />