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JUN-20-2011 07:41 Service Station Systems 408 938 8888 P.03 <br /> 1. FACILITY INFORMATION <br /> Facility Name: $hell#136187 Dale of Testing: 5/20/l 1 <br /> Facility Address: 2375 W Grant Line Road–Tracy,CA 95376 <br /> Facility Contact: phone: <br /> Date Local Agency Was Notified of Testing; SE989-3yr.Compliance Test <br /> Name of Local Agcncy Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:ABLE Maintenance,Inc. <br /> Technician Conducting Test: James Moore/I.C.C.'#5254517-UT <br /> Credentials: 0 CSLB Licensed Contractor r SWPCB Licensed Tank'festcr <br /> License Type:A.B.Hez„CIO License Number: 312844 <br /> Manufacturer T_rainin <br /> Manufacturer Component(s) Date Traiein Ex ires <br /> Available upon request <br /> L — <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Component: pass pail Not Repairs <br /> Component: Pass Fail Tested Made Tested Made <br /> Tank Annular(wet annulars) ❑ ❑ M ❑ UDC 7/8 M ❑ 0 ❑ <br /> 87 A Secondary Product 0 ❑ 0 ❑ UDC 9/10 0 ❑ ❑ ❑ <br /> 89 A Secondary Product 0 ❑ 0 0 UDC 11/12 0 0 ❑ ❑ <br /> 91 A Secondary Product 0 0 ❑ 0 UDC 13/14 Im 17 ❑ D <br /> Diesel A Secondary Product 0 ® 0 ❑ UAC 15/16 ® ❑ ❑ Q <br /> 87 B Secondary Product p 0 ❑ 0 UAC 17/18 ® C1 ❑ <br /> 89 B Secondary Product ❑ W 0 ❑ UAC 19/20 [ Cl ❑ Q <br /> 91 B Secondary Product p 14 ❑ [1 UDC 21/22 ® Q 0 ❑ <br /> 87 A Turbine Sump [ l 0 ❑ 0 87 Fill Sump ® 0 ❑ ❑ <br /> 89 A Turbine Sump 0 ❑ D 89 Fill Sump ® D ❑ Q <br /> 91 A Turbine Sump ❑ ®, ❑ El 91 Fill Sump ! ❑ ❑ d <br /> Diesel A Turbine Sump 0 [9 ❑ 0 Diesel Fill Sump ® ❑ 0 CJ <br /> 87 B Turbine Sump ❑ ❑ 0 Spill Buckets D ❑ ❑ <br /> 89 B Turbine Sump 0 ® 13 ❑ ❑ D ❑ ❑ <br /> 91 B Turbine Sump ❑ ® 0 ❑ C] 0 Cl 0 <br /> UAC 1/2 Q ❑ <br /> UDC 3/4 ® ❑ ❑ ❑ <br /> UDC 5/6 ® ❑ ❑ ❑ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Pump test truck used for testing <br />