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Page of <br />faem=m- <br />Jffrw viro to m era tcs if <br />All Your AB2481 Needs: 909-681-0708 <br />1 _ FACILITY INFORMATION <br />17 AR'7ARl TTCTiN!_!`nNTRAf TnR iNFnRMATTnN <br />Company Name: A & J Environmental <br />Technician Conducting Test: Asa Cosby <br />Credentials: X CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br />License Type and #: A-HAZ 653381 <br />Training by Manufacturer <br />Manufacturer Component(s) Date Training Expires <br />Intelligent Controls IN -CON TS -STS V2.02 2010 <br />Z CITMMARV nF AR7ARI TFV%T RF.CITT.TC <br />Number of Tanks Tested: 0 <br />Number of Piping Runs Tested: 0 <br />Number of Submersible Pump Sumps Tested: 0 <br />Number of UDC Boxes Tested: 0 <br />Number of Fill Sumps Tested: 0 <br />Number of Overfill Boxes Tested: 1 <br />Component Pass Fail <br />Comments <br />Diesel Tank #1 Fill Bucket X <br />"Au pres re tesung must unuze an inert gas. <br />Technician's Signature: Date: <br />7) n i T C T nr%A 4 <br />2 - Z 2 -016 <br />