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• • RECEIVED <br /> FEB 16 2017 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 1.FACILITY INFORMATION <br /> Facility Name: USA/Tesoro#68154 Date of Testing: 1/10/17&1/11/17 <br /> Facility Address: 2500 W.Lodi — Lodi CA 95242 <br /> Facility Contact: Phone: (209)366-0703 <br /> Date Local Agency Was Notified of Testing:1/10/17 SB989—Repair/Re-Test <br /> Name of Local Agency hispector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:ABLE Maintenance,Inc. <br /> Technician Conducting Test: Shawn Sabragia I.C.C.#8307967 <br /> Credentials: ® CSLB Licensed Contractor ❑S WRCB Licensed Tank Tester <br /> License Type:A,B,Elaz.,C10 License Number: 312844 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <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 Secondary Product ® ❑ ❑ ❑ <br /> 89 Secondary Product ® ❑ ❑ ❑ <br /> 91 Secondary Product ® ❑ ❑ ❑ <br /> UDC 1/2 © ❑ ❑ ❑ <br /> UDC 3/4 ® ❑ ❑ ❑ <br /> UDC 5/6 im ❑ ❑ ❑ <br /> UDC 11/12 © ❑ ❑ ❑ <br /> Diesel Fill Sump ® ❑ ❑ ❑ <br /> If hydrostatic testing was performed,describe, was done with the water after completion of tests: <br /> Used pump test truck <br />