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JAN-31-2013 09:32 Serljice Station Systems 408 535 5888 P.03 <br /> 1. FACILITY INFORMATION <br /> Facility Name: Food 4 Less Date of Testing: VW 13 <br /> Facility Address: 14830 Hwy 4—Discovery Bay CA 94514 <br /> Facility Contact: Phone: (209)234-7$49 <br /> Date Local Agency Was Notified of Testing: 12/27/12 58989—3yr.Compliance Tt-st <br /> Name of Local Agency Inspector{'if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:ABLE,Maintenance,Inc. <br /> Technician Conducting Test: .lames Moore/I.C.C.#5254517-UT <br /> Credentials: 2 CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type:A.B,Hat.,C10 Licence Number: 312944 <br /> Mant►Pgcturer Traininr <br /> Manufacturer Com anent s Date Training Expires <br /> Available upon request <br /> 3. SUMMARY OF TEST RESULTS <br /> Component: Pass Fail Not Repairs Component: Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> 87/91 Tank Annular 193 <br /> 87 Secondary Product <br /> 91 Secondary Product 191 <br /> 87 Turbine Sump <br /> 91 Turbine Sump1 <br /> UTC 1/2 <br /> UDC 3/4 �) <br /> UDC S/6 Im <br /> F TDC 7/8 <br /> UDC 9/10 p <br /> 87 Fill Sump <br /> 91 Fill Sump <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Used pump test truck <br />