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+ FEB—�7-2011 16.23 Service Station Systems 408 938 8888 P.02 <br />SWRCS, January 2006 <br />This <br />printouts tests Intended (if applicable), hould be provided to the fannual cilitty ownefterator forUST spill containment <br />submitStructures. <br />tal to the local reghe u atory agency and <br />Facility Name. Shall/Tesoro Date of <br />Facility Address: 35 N. Cherokee Ln. Lodi, CA 95240 <br />Facility contact: Grace Keller (209) 369-1525 <br />Date Local Agency Was Notified of Testing: 1/10/11 <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INF©RMATION <br />Company Name: Service Station Systems <br />Technician Conducting Test; Bryan Lundien <br />Credentiaist : CSLB Contractor ® ECC Service Tech. [3 SWRCB Tank Tester ❑ Other <br />License Number(s): License; 485184 ICC:8001468-UT <br />1/20/11 <br />Comments: Include information on repairs made prior to testing, and recommended follow-up for failed tests. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />,hereby cet?lfy that all the information contained /n this report IS tr u9, accutate,and in full corriptlance with legal regalt+ements. <br />Technician's Signature: <br />� Date_, 1120/11 <br />1 State taws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />