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TOTAL PETROLEUM SERVICES <br />All Your SB989 Needs: (951) 377-5997 <br />1. <br />RECE*ED <br />D E C 19 2012 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />FACII,ITY INFORMATION <br />Facility Name: Unified Grocers Date of Testing: 11-21-12 <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 (f present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Page 1 of 6 <br />Company Name: Total Petroleum Services <br />Pass <br />Technician Conducting Test: Chris Edwards <br />Not Repairs <br />Tested Made <br />Credentials: X CSML, „ c0nuacw <br />0 SWRCB Licensed Tank Tester <br />License Type: C61-1340 <br />Repairs <br />Made <br />License Number: 915252 <br />Manufacturer <br />Manufacturer Training <br />Component(s) Date Training Expires <br />Intelligent Controls IN -CON TS -STS V2.02 2014 <br />0 <br />0 <br />0 <br />0 <br />Diesel S STP <br />X <br />3. SUMMARY OF TEST RESULTS <br />Component <br />Pass <br />Fail <br />Not Repairs <br />Tested Made <br />Component Pass <br />Fail <br />Not <br />Tested <br />Repairs <br />Made <br />Diesel N STP <br />X❑ <br />❑ ❑ <br />0 <br />0 <br />0 <br />0 <br />Diesel S STP <br />X <br />❑ <br />❑ ❑ <br />0 <br />❑ <br />0 <br />0 <br />Diesel annular <br />X <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />0 <br />0 <br />Diesel 2" secondary line <br />X <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />0 <br />Diesel 3" secondary line <br />X <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />0 <br />❑ <br />UDC <br />X <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />0 <br />0 <br />Diesel spill bucket <br />X <br />1 ❑ <br />0 ❑ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />❑ 0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 0 <br />0 <br />0 <br />❑ <br />0 <br />0 <br />0 <br />0 ❑ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 ❑ <br />0 <br />0 <br />0 <br />0 <br />❑ <br />j 0' <br />❑ 1 0 <br />0 <br />0 <br />❑ <br />❑ <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: E Date: l' -Ll — it <br />