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Page 1 of 2' <br /> Ens�ironmentcal <br /> All Your AB2481 Needs:909-681-0708 <br /> 1. FACILITY INFORMATION <br /> Facility Name: Unified Western Grocers Date of Testing: 12/22/08 <br /> Facility Address: 1990 Piccoli St.,Stockton CA.95215 <br /> Facility Contact: Pat Guillermety Phone: 323-264-5200#8648 <br /> Date Local Agency Was Notified of Testing: 11/14/07 <br /> Name of Local Agency Inspector Present: Inspector <br /> 2. AB2481 TESTING CONTRACTOR INFORMATION <br /> Company Name: A&J Environmental <br /> Technician Conducting Test: Asa Cosby <br /> Credentials: X CSLB Licensed Conbutor ❑SWRCB Licensed Tank Tester <br /> License Type and#: A-HAZ 653381 <br /> Training by Manufacturer <br /> Manufacturer Component(s) Date Training Expires <br /> Intelligent Controls IN-CON TS-STS V2.02 2010 <br /> 3. SUMMARY OF AB2481 TEST RESULTS <br /> Number of Tanks Tested: 0 Number of Piping Runs Tested: 0 <br /> Number of Submersible Pump Sumps Tested: 0 Number of UDC Boxes Tested: 0 <br /> Number of Fill Sumps Tested: 0 Number of Overfill Boxes Tested: 1 <br /> Component Pass Fail Comments <br /> Diesel Tank#1 Fill Bucket X <br /> *All pr retesting must utilize an inert gas. *� <br /> Technician's Signature: Date: G <br /> T3 n T 0 m nfNw r <br />