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A 4 W=M- Essvia-pras»en teat All Your SB989 Needs: (951) 681-0708 FACILITY INFORMATION • Page 1 of 6 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 (if present during testing): John J. Iackson R.E.H. S. 2. TESTING CONTRACTOR INFORMATION Company Name: A & J Environmental Service's Inc. Technician Conducting Test: Jason Cosby Not Repairs Tested Made Credentials: X CSLB Lit enad C40USCW ❑ SWRCB Licensed Tank Tester License Type: A-Haz Manufacturer License Number: 653381 Manufacturer TraininE Component(s) Date Training Expires Intelligent Controls IN -CON TS -STS V2.02 2007 ❑ ❑ ❑ ❑ ❑ ❑ South Diesel Turbine Sump X 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Tested Made Component Pass Fail Not Tested Repairs Made Diesel Tank Annular Space X ❑ ❑ ❑ ❑ ❑ ❑ ❑ South Diesel Turbine Sump X ❑ ❑ ❑ ❑ ❑ ❑ ❑ North Diesel Turbine Sump X ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ South Diesel Piping Run X ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ North Diesel Piping Run X ❑ ❑ ❑ ❑ ❑ ❑ ❑ Dispenser Containment Box ❑ X ❑ ❑ ❑ ❑ ❑ ❑ Diesel Fill Bucket X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 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 knowiedge, d wjac is stated in this Apeument are accurate and in frill compliance with lege[ requirements Technician's Signature: ( \ Date: 10 to