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0 0 Page I of <br />All Your AD2481 Needs: 909-691-0708 <br />I- 1RAr1T.1TV INWIRMATION <br />Facility Name: Unified Westem Gro, ers I J)ate of Testing: 12/30/03 <br />Facility Address: 1990 Piccoli St., Stockton CA. 95215 <br />Facility Contact: Pat Gufflermety <br />Phone: 323-264-5200 #8648 <br />Date Local Agency Was Notified of Testing: 12/11/03 <br />Name of ;al Agency Inspector Present: Inspector John Jackson <br />2. AB2481 TESTING CONTRACTOR INFORMATION <br />Company Name: A & J Environmental <br />0 <br />Technician Conducting Test: Jason Cosby <br />Number of Submersible Pump Sumps Tested: 0 <br />Credentials: x q 0 SVv1RCB Licensed Tank Tester <br />License Type and #: A-HAZ 653381 <br />0 <br />Manufacturer <br />Training by Manufacturer <br />Component(s) Date Training Expires <br />Intelligent Controls <br />IN -CON TS -STS V2.02 2005 <br />Diesel Tank #1 Fill Bucket <br />x <br />3. SUMMARY OF AB2481 TEST RESULTS <br />Number of Tanks Tested: <br />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: <br />0 <br />Number of Overfill Boxes Tested: I <br />Component <br />Pass Fail <br />Comments <br />Diesel Tank #1 Fill Bucket <br />x <br />pre ure testi must utilize an inert gas. <br />Technician's Signature: <br />Date:/.?c) Ito .5 <br />R.C.U.S.T.COM \, _/ -1111' January 2004 <br />