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a6= --um, <br />H"V1V*C)0j*Ma&2 tell <br />All Your AB2481 Needs: 909-681-0708 <br />1. FACELX17Y INFORMATION <br />Page f of 2_ <br />FacilityName: Unified Western Grocers Date of Testing: 11-21-06 <br />Facility Address: 1990 Piccoli Rd, Stockton CA. 95215 <br />Facility Contact: —Pat Guillermety T—Phone: 323-264-5200 #8648 <br />Date Local Agency Was Notified of Testing: 0~ (/ - 4 - oc <br />Name of Local Agency Inspector Present: Inspector bindenina V1 'A <br />2. AB2481 TESTING CONTRACTOR INFORMATION <br />3. SUMMARY OF AB2481 TEST RESULTS <br />Number of Tanks Tested: 0 Number of Piping Runs Tested: 0 <br />SOLD Me #TMI An -TOM -07,313 Number of UDC Boxes Tested: 0 <br />Number of Fill Sumps Tested: 0 Number of Overfill Boxes Tested: I <br />mr,11T. ml - <br />Diesel Tank #1 Fill Bucket <br />*A[wressure testing must utilize an inert gas. <br />Technician's Signature: <br />Date: I I - -2-1 - L',;, <br />R.C.U.S.T.COM January 2004 <br />