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DEC-05-2011 10:24 SERVICE STATION 14089388888 P.03 <br /> c�,�'•' as <br /> r• <br /> 1. FACILITY INFORMATION <br /> Facility Name; Safeway#2600 Date of Testing: 11/16/11 <br /> Faciliry Address; 1804 W.11'r Street—Tracy CA 95376 <br /> Facility Contact: Phonc; <br /> Date Local Agency Was Notified of Testing: SB989—3yr,Compliance Test <br /> Name of Local Agcncy Inspector(rfpresent during testing): <br /> r: <br /> 2. TESTING CONTRACTOR INFORMATION y <br /> Company Namc:ABLE Maintenance,Inc. <br /> t� <br /> Technician Conducting Test; dames Moore/I.C.C.#5254$17-UT <br /> Credentials; CSLU Licensed Contractor LI SWITCH Licensed Tank Tester <br /> .� .1 <br /> I,icense Type;A,B,Ilaz.,C10 Licensc Number: 312844 <br /> Manufacturer Tr_ainina <br /> Manufacturer Component(s) Datc Training Expires, " <br /> Available upon request <br /> 3. SUMMARY OF TEST RESULTS -, <br /> Component: Pass Fail Not Repairs Component: pass Fail Not MEI <br /> ?j.,.ti _ <br /> Tested Made Tested <br /> 87 Tank Annular C1 ❑ ❑ ❑ UDC 13/14 [Sl ❑ ❑91/Diesel Tank Annular ® 0 ❑ ❑ UDC 15/1fi ® ❑ ❑87 Secondary Product ® ❑ ❑ ❑ UDC 17/1891 Secondary Product ® ❑ ❑ p UDC 19/20 •` s <br /> Diesel Secondary Product ® ❑ ❑ ❑ 87 Fill Sump ® ❑ �] ❑ ;"�. <br /> 87 Turbine Sump ® ❑ ❑ ❑ 91 Fill Sump ® ❑ ❑ ❑ <br /> 91 Turbine Sump ❑ p ❑ Diesel Fill Sump ® ❑ ❑ ❑ <br /> Diesel Turbine Sump 191 ❑ ❑ ❑ Spill Buckets 13 ❑ <br /> UDC 1/2 ® Q ❑ ❑ ❑ ❑ ❑ ❑ <br /> UAC 3/4 Q1 ❑ ❑ ❑ <br /> UDC 5/6 ® ❑ ❑ ❑ ❑ 1 ❑ i ❑ ❑ <br /> UDC 7/8 ® ❑ 0 ❑ ❑ ❑ <br /> UDC 9/10 'T <br /> Irl ❑ o ❑ a ❑ ❑ o ;,, , <br /> UDC 11/12 ❑ 11 El <br /> ,1 <br /> If hydrostatic testing was perfortrted, describe what was done with the water after completion of tests: <br /> Pump test truck used <br /> s• <br />