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1\77A(.NMCJ T A <br /> Afforda-Te$t - Work Order _ Date <br /> 416 2nd Street Galt,Ca 95632 Tech: -r-/A N C <br /> 209 744-0112 <br /> Si � Monitor V r Recovery ines <br /> , <br /> R <br /> Alarm Respons /Lbr Or ❑ <br /> 11oU �. utklf� 4Sr9i 'L--( AN-4C. L CA. `= 533-4 <br /> Testing/Rprs Passed No Parts Needed Parts Replaced: Parts Needed: <br /> Repairs Needed: f' c ' i" u- -,\P323 5c; <br /> V JC_is <br /> a- N 9 1 r,r t F <br /> "t;. f ACrVk <br /> Lid Bolts: OK #Missing or Stripped ❑ <br /> / t <br /> Site Representative(print): <br /> Results sent upon receipt ofpayment. Most regulatory agencies require <br /> results within 30 days of testing. Please plan your payment accordingly. Site Representative Signature: e- <br /> *Any issues within a few days of testing could be related to this testing,so site must call us BEFORE maintenance repairs are done by others. <br />