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JUL-27-2011 15:32 Se ice Station Systems 408 938 8888 P.03 <br /> 1. FACILITY INFORMATION <br /> Facility Name: Shell#136187 Date of Testing: 6/28/11 <br /> Facility Address; 2375 W Grant Line Road—Tracy,CA 95376 <br /> Facility Contact; I Phone: <br /> Date Local Agency was Notified of Testing; SB989—Repair/Retest <br /> Name of Local Agency inspector(ii present during testing); <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name;ABLE Maintenance,Inc. <br /> Technician Conducting Test: Kelly Burninghaan ICC#52.50610—t_J_t <br /> Credentials; ® CSLB Licensed Contractor 11 SWRC13 I.1censed Tank Tester <br /> License'rype:A,B,Haz.,CIO license Number; 312844 <br /> M.an ufasturer.Training <br /> Manufacturcr Component(s) Date Training Fx ire.+ <br /> Available upon request <br /> 3. SUMMARY OF TEST RESULTS <br /> Component: Pass Fail Not Repairs Component: Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> 87 A Secondary Product ! ❑ ❑ ® ❑ ❑ ❑ Q <br /> 89 A Secondary Product ® ❑ ❑ ❑ D ❑ ❑ <br /> 91 A Secondary Product ® ❑ Q ® ❑ O D ❑ <br /> Die-set A Secondary Product ® ❑ ❑ ® ❑ ❑ ❑ ❑ <br /> 5713 Secondary Product ® p 0 ® ❑ ❑ ❑ ❑ <br /> 89 B Secondary Product 0 ❑ ❑ LSI ❑ ❑ ❑ ❑ <br /> 91 B Secondary Product 0 ❑ ❑ ❑ D ❑ ❑ <br /> 87 A Turbine Sump IM ❑ ❑ ® ❑ ❑ ❑ ❑ <br /> 89 A Turbine Sump 0 p ® M ❑ ❑ ❑ ❑ <br /> 91 A Turbine Sump ® ❑ ❑ ® D ❑ ❑ Q <br /> Diesel A Turbine Sump ® ❑ ❑ ® ❑ D Q 0 <br /> 87 B Turbine Sump ® ❑ ❑ ® ❑ 1 ❑ ❑ ❑ <br /> 59 B Turbine Sump ® Q p ® ❑ D ❑ ❑ <br /> 91 B Turbine Sump ® 0 ❑ t ❑ ❑ ❑ ❑ <br /> 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ <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 />