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t <br />Page of <br />Er+vironmentul <br />All Your SB989 Needs: 909-681-0708 <br />FACILITY INFORMATION <br />Facility Name: United Western Grocers Date of Testing: 2/18/09 <br />Facility Address: 1990 Piccoli Rd., Stockton CA. <br />Facility Contact: Fleet Manager Phone: 209 931-1990 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector Present: Jeff Wong <br />TESTING CONTRACTOR INFORMATION <br />Company Name: A & J Environmental <br />1 <br />Technician Conducting Test: Asa Cosby <br />Number of Submersible Pump Sumps Tested: 2 <br />Credentials: X <br />❑ SWRCB Licensed Tank Tester <br />License Type and #: A-HAZ 653381 <br />Number of Overfill Boxes Tested: 0 <br />Manufacturer <br />Training by Manufacturer <br />Component(s) Opt Training Expires <br />Incon ST -STS <br />Sump tester Y-20-2010 <br />X <br />Diesel Turbine Sump north <br />X <br />Diesel Turbine Sump south <br />X <br />SUMMARY OF TEST RESULTS <br />Number of Tanks Tested: <br />1 <br />Number of Piping Runs Tested: 2 <br />Number of Submersible Pump Sumps Tested: 2 <br />Number of UDC Boxes Tested: 1 <br />Number of Fill Sumps Tested: <br />1 <br />Number of Overfill Boxes Tested: 0 <br />Component <br />Pass Fail <br />Comments <br />Diesel Annular Space <br />X <br />Diesel Turbine Sump north <br />X <br />Diesel Turbine Sump south <br />X <br />Diesel Fill bucket <br />X <br />Diesel Product Line <br />X <br />Diesel Product Line 2 <br />X <br />Dispenser 01 <br />X <br />C% '�(l�All pr re testing must utilize an inert gas. <br />Technician's Signature: Date: <br />D !n T r 0 'T /"YV, 4 <br />