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S"CB, January 2002 RECZtVED <br />,a S <br />.70r S D <br />1. FACILITY INFORMATION <br />1JS 2 71 " il <br />Date of Testing: Dec 11 2 013 <br />Facility Ad :1700 Yosemite, Manteca,CA.95336 <br />�_facilityCo, ct: Hasina Nasir Phone: 209-823-7676 <br />...�eliab e Petroleum <br />_SompanyNanj�� <br />17=31an Conducting Test:ELnie <br />Servic <br />redentials: 2CSLB Licensed Contractor <br />0 SWRCB Licensed Tank Tester <br />"Fit <br />License Number: 8 8 3 7 0 6 <br />Manufacturer <br />Manufacturer Trainin <br />QojmggaeaL( Date Training EvDires <br />I-ACON <br />TS—STS-Aug. 06 , 2014 <br />Service Tech Aug. 10 , 2015 <br />Annular 91 <br />3. $1111TINLIKTOF <br />Component <br />TEST <br />]?1vA,S`11,LTS <br />Component <br />.Annular 87 <br />Annular 91 <br />Secondary 87 <br />S acondary— 91 <br />UDC 5 <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTIFICATION 0 TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, th st ted in this document are accurate and In fry compliance with legal requirements <br />Technician's Signature. Date: Dec. 11 2013 <br />