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e <br />ErsvitroismC»tal <br />All Your AB2481 Needs: 909-681-0708 <br />1. FACIIdTY INFORMATION <br />Page i ofd <br />Facility Name: Unified Western Grocers Date of Testing: 11-21-06 <br />Facility Address: 1990 Piccoli Rd.., Stockton CA. 95215 <br />Facility Contact: Pat Guillermety Phone: 323-264-5200 #8648 <br />Date Local Agency Was Notified of Testing: I ) - i4 - pt, <br />Name of Local Agency Inspector Present: Inspector admobmbM w <br />2. AB2481 TESTING CONTRACTOR INFORMATION `) <br />Company Name: A & J Environmental <br />Number of Piping Runs Tested: 0 <br />Technician Conducting Test: Asa Cosby <br />Number of UDC Boxes Tested: 0 <br />Credentials: X CSLB Licensed Contractor <br />0 SWRCB Licensed Tank Tester <br />License Type and #: A-HAZ 653381 <br />Manufacturer <br />Training by Manufacturer <br />Component(s) Date Training Expires <br />rLI cc. <br />S+ 07 <br />3. SUMMARY OF AB2481 TEST RESULTS <br />Number of Tanks Tested: 0 <br />Number of Piping Runs Tested: 0 <br />Number of Submersible Pump Sumps Tested: 0 <br />Number of UDC Boxes Tested: 0 <br />Number of Fill Sumps Tested: 0 <br />Component Pass Fail <br />Number of Overfill Boxes Tested: 1 <br />EM <br />Comments <br />Diesel Tank #1 Fill Bucket <br />All pr are testing must utilize an inert gas. <br />Technician's Signature: <br />R.C.U.S.T.COM <br />Date: 0- 21-0b <br />January 2004 <br />