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t Page 1 of 6 Ehrsvira»n»ehre tvl All Your SB989 Needs: (951) 681-0708 1. FACILITY INFORMATION Facility Name: United Western Grocers Date of Testing: 10/05/2005 Facility Address: 1990 Piccoli Rd., Stockton CA. Facility Contact: Pat Guillermety Phone: (626) 458-3559 Date Local Agency Was Notified of Testing: 09/28/2005 Name of Local Agency Inspector (ifpresent during testing): John J. Jackson R.E.H.S. 2. TESTING CONTRACTOR INFORMATION Company Name: A & J Environmental Service's Inc. Technician Conducting Test: Jason Cosby Credentials: X CSLB Licellsed. Counut" ❑ SWRCB Licensed Tank Tester License Type: A-Haz License Number: 653381 Manufacturer Training Manufacturer Component(s) Date Training E ires Intelligent Controls IN -CON TS -STS V2.02 2007 3. SUMMARY OF TEST RESULTS Component Pass Fail NotRepairs Tested Component pass Made Fail Not Tested Repairs Made Diesel Tank Annular Space X ❑ ❑ ❑ ❑ ❑ ❑ ❑ South Diesel Turbine Sump X ❑ ❑ ❑ ❑ ❑ ❑ ❑ North Diesel Turbine Sump X ❑ ❑ ❑ ❑ ❑ ❑ ❑ South Diesel Piping Run X ❑ ❑ ❑ ❑ ❑ ❑ ❑ North Diesel Piping Run X ❑ ❑ ❑ ❑ ❑ ❑ ❑ Dispenser Containment Box ❑ X ❑ ❑ ❑ ❑ ❑ ❑ Diesel Fill Bucket X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ L ❑ ❑ ❑ ❑ ❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: Water Was Hauled Away With Testing Company To Be Re -Used For Future Testing CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best ofmy knowledge, the sds stated in this merat are accurate and in full compliance with legal roequinements Technician's Signature: rte-+. Date: t O