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9255517888 Line 08'11:30 a.m. 06-01-2011 1 /1 <br /> R NED <br /> GETTLER - RYAN INC. 1UN Z011 <br /> HFALTH <br /> PERMIT/SERVICES <br /> TE ING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/O#,CV N <br /> Notification Date: \ Notification For: <br /> Requested Test Date: u1 Repairs <br /> Initial Test <br /> Facility Name: Re-Test <br /> Site Name 1 Facility#: C <br /> 2 ekL <br /> Address: <br /> '-�Q \ 1V <br /> City,State: <br /> Agency Notified: Method: <br /> Contact Person: ' Verbal <br /> Fax <br /> Telephone <br /> E-Mail <br /> Fax#: � ' � <br /> Testing Scope(check all components that apply) <br /> TP-201.4/ST-27 Back Pressure r� Tank Monitor Cert/Bucket Test <br /> TP-201.3/ST-30 PSI Decay 3-GPH Simulation u <br /> TP-201.6/ST-37 Liquid Removal TP-201.16 Static Torque <br /> TP-201.3B/ST-38 PSI Decay AST Drop Tube/Overfill TP-201.1D <br /> TP-201.5/ST-39 Air/Liquid Secondary Containment <br /> Repair Scope <br /> v� Q71C I )m, t Z P�. <br /> oo� <br /> Notification Contact: j Telephone: 925-551-4777 <br /> 6747 Sierra Court, Suite J • Dublin, CA 94568 • (925) 551-7555 • Fax (925) 551-7888 <br /> 3140 Gold Camp Drive, Suite 170 • Rancho Cordova, CA 95670 • (916) 631-1300 • Fax (916) 631-1317 <br /> 1364 N. McDowell Blvd., Suite B2 • Petaluma, CA 94954 • (707) 789-3255 • Fax (707) 789-3218 <br />