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t <br />All Your AB2481 Needs: 909-681-0708 <br />1. FACILITY INFORMATION <br />Page ( of <br />r <br />Company Name: A & J Environmental <br />Technician Conducting Test: Jason Cosby <br />Credentials: X CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester <br />License Type and #: A-HAZ 653381 <br />Training by Manufacturer <br />Manufacturer Component(s) Date Training ELcpires <br />Intelligent Controls IN -CON TS -STS V2.02 2005 <br />Number of Tanks Tested: <br />0 <br />Number of Piping Runs Tested: 0 <br />Number of Submersible Pump Sum Tested: 0 <br />Number of UDC Boxes Tested: 0 <br />Number of Fill Sum Tested: <br />0 <br />Number of Overfill Boxes Tested: 1 <br />Component <br />Fait <br />Comments <br />Diesel Tank #1 Fill Bucket <br />-Pass <br />X <br />X <br />ga <br />Technician's Signature: <br />RC. U.S.T.COM <br />.An pXqsure testing must utuize an inert gas. <br />Date: <br />Januai), 200- <br />r <br />