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TOTAL PETROLEUM SERVICES <br />All Your SB989 Needs: (951) 377-5997 <br />1. FACILITY INFORMATION <br />Name: Unified Grocers <br />0 <br />Page 1 of 6 <br />Date of <br />Facility Address: 1990 Piccoli Street Stockton, CA 95215 <br />Facility Contact: Pat Guillermety Phone: 323-264-5200 <br />Date Local Agency Was Notified of Testing: 11-12-12 <br />Name of Local Agency Inspector (if present during testing): <br />Ic ►Y'Y! ! 1►1' I) C kv a al <br />j -�� �i�• ,: ' , �••, � - -- <br />11-21-12 <br />3. SUMMARY OF TEST RESULTS <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water Was Hauled Away With Testing Company To Be Re -Used For Future Testing <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature:04�' �"�` Date: 11 ~ z/ ' Z" <br />Component <br />Diesel N <br />Diesel S STP <br />moon <br />11 Diesel 2" secondarySTP <br />':'Diesel 3" secondary line <br />0000�' <br />oo©o <br />oi000 <br />mom <br />MOM <br />0000 <br />0000 <br />i00000 <br />aonio <br />noon <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water Was Hauled Away With Testing Company To Be Re -Used For Future Testing <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature:04�' �"�` Date: 11 ~ z/ ' Z" <br />