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9255517888 Line 1 r^' '5:41 p.m. 03-06-2009 1 i1 C;9 <br /> C7ETTLER - RYAN NC. AIA R 09 ?0 <br /> En;, ✓QUNry <br /> NE+L1 r ~,,TAL <br /> TESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/O#: 2D zt/ <br /> Notification Date: Notification For: <br /> Requested Test Date: to I o 4 r -) Initial Test <br /> Facility Name: dk- lo,4 Repairs <br /> F-1 <br /> Site Name Facility N: p2�MIDRe-Test a <br /> Address: ! a_ <br /> Ci ,State: <br /> A ency Notified: 7oaQd2 n f4:) Method: <br /> Contact Person: Verbal <br /> Fax <br /> Telephone: E-Mail <br /> Fax N: - co> c{� Confirm Date/Time: <br /> Tech: <br /> Testing Scope(check a it components that apply) <br /> ST-27 Back Pressure/TP 201.4 Q Tank Monitor Certification <br /> ST-30 PSI Decay USY TP 201.3 3-GPIs Leak Simulation <br /> ST-37 Liquid Removal/TP 201.6 Static T&rque TP-201.1B <br /> ST-38 PSI Decay AST' TP 201.3B Drop Tube/Drain Valve TP 201.1C <br /> ST-39 Air/Liquid/ TP 201.5 Drop Tube OVERFILL TP-201.1D <br /> rREPA1,R SCOPE (desurbecomponenesandanrcipaledrepais) <br /> 0sl hon l oy-) <br /> Notification Contact: Telephone: (925)551-4777 <br /> Scope of Work Contact: Telephone: <br />