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Afforda-Te$t - Work Order Date `( <br /> 416 2nd Street Galt,Ca 95632 Tech; - `' <br /> 209 744-0112 <br /> Site: Monitor ❑ Vpr Recovery ❑ Tanks/Lines ❑ <br /> Jl��fj� y Alarm Response./_.Lbr/Other <br /> / J� A <br /> ❑ Testing/R rs Passed ® No PartslNeededParts Replaced: Parts Needed: <br /> g pF1 Repairs Needed: r't , /6 L /'4 � 1 �/i P t t=C-t� Al(.l �"� <br /> r <br /> Lid Bolts: OK ❑ #Missing or Stripped ❑ • <br /> Site Representative(print): <br /> Results sent upon receipt of payment. Most regulatory agencies require 7 <br /> Site Representative Signature:&" <br /> results within 30 days of testing. Please plan your payment accordingly. ' <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 /> • <br />