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l d 3 <br />All Your SB989 Needs: (951) 681-0708 <br />1. <br />jjj <br />HEALTH <br />RE -TEST <br />FACILITY INFORMATION <br />Page 1 of 2 <br />Facility Name: United Western Grocers Date of Testing: 02/01/2006 <br />Facility Address: 1990 Piccoli Rd., Stockton CA. <br />Facility Contact: Pat Guillermety Phone: (626) 458-3559 <br />Date Local Agency Was Notified of Testing: 01/25/2006 <br />Name of Local Agency Inspector (f present during testing): Willy Ng, SR. R.E.H.S. <br />2. RE -TESTING CONTRACTOR INFORMATION <br />Company Name: A & J Environmental Service's Inc. <br />Technician Conducting Test: Jason Cosby <br />Credentials: X CSLB Licensed Contractor <br />❑ SWRCB Licensed Tank Tester <br />License Type: A-Haz <br />License Number: 653381 <br />Manufacturer <br />Manufacturer Training <br />Component(s) Date Training Expires <br />Intelligent Controls <br />IN -CON TS -STS V2.02 2007 <br />oomm, <br />3. SUMMARY OF RE -TEST RESULTS <br />1 It 1 1 I 1 <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water Was Hauled Away With Testing Company To Be Re -Used For Future Testing <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and In full compliance with legal r qulremenes <br />Technician's Signature: C9 6t4, p Date: <br />zmI'1 <br />1 II 1..'._I.. I ___. -zm^I <br />1.. <br />_.•... 1 1 <br />Dispenser Contalmnent Box <br />©o=© <br />oomm, <br />00000o00 <br />0000 <br />0000 <br />0000 <br />0000. <br />0000 <br />. <br />0000 <br />. <br />. <br />0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />�. <br />000■0 <br />0000 <br />0000 <br />0000 <br />�� <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water Was Hauled Away With Testing Company To Be Re -Used For Future Testing <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and In full compliance with legal r qulremenes <br />Technician's Signature: C9 6t4, p Date: <br />