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RCEI VEE <br />SEP p 3 2015 <br />ENVIRONMENTAL <br />FACILITY INFORMATION 1-IOaITU n=Ao7AACkM <br />FacilitN Name Safeway 0 2707 Date of Testing: 8/7/1 S <br />Facili(� Address: 6425 N. Pacific Avenue — Stockton CA 95207 <br />Facility Contact: Phone: (209) 472-8600 <br />Date Local Agency Was Notified of Testing : SB989-6 month Compliance results <br />Name of Local Agency Inspector /ijpreseni during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: ABLE Maintenance, Inc. <br />Component: Pass Fail Not Repairs <br />Tested Made <br />Technician Conducting lest: James Moore/ I.C.C. 05254517 -UT <br />Credentials: ® CSLB Licensed Contractor <br />SWRCB Licensed Tank fester <br />License Type: A. B. Haz., CIO <br />I License Number: 312844 <br />Manufacturer <br />Manufacturer Training <br />Component(s)) Date Trainin& Expires <br />Available upon request <br />3. SUMMARY OF TEST RESULTS <br />Component; Pass Fail Not Repairs <br />Tested Made <br />Component: Pass Fail Not Repairs <br />Tested Made <br />Y� <br />I <br />L <br />If hydrostatic testing was performed, describe what was done with the water atter completion of tests: <br />Used puma test truck <br />