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JAN -30-2013 10:48 Service Station Systems <br />FACTLTTV 1NFr1RMATT0N <br />408 938 8888 P.03 <br />Facility Name! Safeway # 2707 Dalo of Testing: 1/8/13 <br />Facility Address: 6425 N. Pacific Avenue—Stnekton CA 95207 <br />Facility Contact: Phone: (209) 472-86(X) <br />Date Local Agency Was Notified of Testing: 12/27/12 SB989-3yr. Compliance Test <br />Name of Local Agency inspector (if presenr during testing): <br />iaaanctn <br />Company Name: ABLE Maintenance, Inc, <br />Technician Conducting Test: James Moore / I.C.C. #5254517 -UT <br />Credentials: 0 CSLB Licensed Contractor SWRCB Licensed Tank'festcr <br />License Type: A. 9, flaz., CIO I License Numbers 312844 <br />upon request <br />a PTTX4X4ARV nF TFCT Rou1T.'1'C <br />Component; Pass Fail Not Repairs <br />Made <br />Component: Pass Fail TNot Re de <br />Tested <br />87 Tank Annular <br />IR <br />I <br />UDC 5/6 Rl <br />91/Diesel Tank Annular <br />O <br />UDC 7/8 El <br />87 Secondary Product <br />p <br />UDC 9/10 1 <br />91 Secondary Product <br />® <br />UDC 11/12 181 <br />Diesel Secondary Product <br />® <br />UDC 13/14 ml <br />87 Vent <br />® <br />UDC 15/1.6 f$! <br />91 Vent <br />® <br />87 Fill Sump <br />Diesel Vent <br />® <br />91 Fill Sump LRl <br />Vapor <br />® <br />Diesel Fill Sump <br />87 Turbine Sump <br />®I <br />t <br />Vent Sump Im <br />91 Turbine Sump <br />f2S! <br />Diesel Turbine Sump <br />UDC 1/2 <br />UDC 3/4 <br />Gl <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />test truck <br />