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Page I of Z <br /> Enviroraer.taX <br /> All Your AB2481 Needs: 909-681-0708 <br /> 1. FACILITY INFORMATION <br /> Facility Name: Unified Western Grocers Date of Testing: 11/21/07 <br /> Facility Address: 1990 Piccoli St., Stockton CA. 95215 <br /> Facility Contact: Pat Guillermety Phone: 323-264-5200#8648 <br /> Date Local Agency Was Notified of Testing: 11/14/07 <br /> Name of Local Agency Inspector Present: Inspector Toua Yang <br /> 2. AB2481 TESTING CONTRACTOR INFORMATION <br /> Company Name: A&J Environmental <br /> Technician Conducting Test: Asa Cosby <br /> Credentials: X CSLB Licensed Contractor D SWRCB Licensed Tank Tester <br /> License Type and#: A-RAZ 653381 <br /> Training by Manufacturer <br /> Manufacturer Component(s)) Date Training Expires <br /> Intelligent Controls IN-CON TS-STS V2.02 2008 <br /> 3. SUMMARY OF AB2481 TEST RESULTS <br /> Number of Tanks Tested: 0 Number of Piping Runs Tested: 0 <br /> Number of Submersible Pump Sumps Tested: 0 Number of UDC Boxes Tested: 0 <br /> Number of Fill Sumps Tested: 0 Number of Overfill Boxes Tested: 1 <br /> Component Pass Fail Comments <br /> Diesel Tank 41 Fill Bucket <br /> *A pressure testing must utilize an inert gas. <br /> Technician's Signature: Date: P <br /> n n T T V T 01-NN T T inn <br />