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NOV-11-2011 15:20 Service Station Systems 408 938 8888 P.03 <br /> 1. FACILITY INFORMATION <br /> Facility Namc: SHELL/USA #68153 Date of Testing- (0/19/11 <br /> Facility Address: 2448 W.Kettleman Lane—Lodi CA 95242 - <br /> Facility Contact: Phone (209)369-3124 <br /> Date Local Agency Was Notified of Testing: SB989—6 month follow up <br /> Name of Local Agency Inspector(if present during testing): <br /> z. TESTING CONT%tCTOR INFORMATION <br /> Company Name:ABLE Maintenance.Inc. <br /> Technician Conducting Test: James Moore.ICCs#5254.517-LIT _ <br /> Credentials: ® CSLB Licensed Contractor � SWRCB Licensed Tank Tester <br /> License Type: A,Il,Iiaz.,CIO license Number: 312844 �- <br /> i �;a,'I jjr�{%"���I° i°',i,�x�•�"><:,tl:�.- i�'br e�i� � ,w�'' 9+i,�.,,.,i 1.. ,..�"�•'i�al.. .� r aii9 �,Nk,h:. <br /> Manufacturer Trainino <br /> Manufacturer Com oncnt s Date Training Expires <br /> Available upon request <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repairs <br /> Component: Pass Fail Tested Made I Component: Pass Fail Tested Made <br /> 91 Turbine Sump ® ❑ ❑ ❑ I ❑ ❑ ❑ ❑ <br /> Diesel Turbine Sump O p Lo E01 ❑ ❑ <br /> ❑ Q ❑ --❑l ❑ ❑ ❑ ❑ <br /> El 11 El El 11 0 <br /> [Ell 11 11 El 1 Eli <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ I i ❑ ❑ 1 ❑ ❑ i, <br /> ❑ ❑ ❑ ] ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ n ❑ ❑ <br /> ❑ ❑ Cl ❑ ❑ ❑ ❑ ❑ <br /> 0 'I ❑ ❑ ❑ ❑ i ❑ ❑ i ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ 0 <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Pump test truck used for testine <br />