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9255517888 Line 08-"r:33 a,rn. 11-25-2008 <br /> NOV 242008 <br /> E T T L E R - YA NINC. StiEW( hij'0,j I:O jNTY <br /> NTai <br /> •I'!=PA.RTMENT <br /> TESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/O#: 7 D - ,J Lt 3 2� <br /> Notification Date: Notification For: <br /> Requested Test Date: l 2 d 106-r'"' Initial Test El <br /> Facility Name: Repairs <br /> Site Name Facility#: © 0 U Re-Test F <br /> Address: S5 <br /> r—,f <br /> City,State: L (=.V� <br /> A tncy Notified: bYI Method: <br /> Contact Person: Verbal Q <br /> Fax �- <br /> Telephone: 2 2 E-Mail <br /> Fax#: � u i� J Confirm Date/Time: <br /> Tech: <br /> Testing Scope(chackall components that apply) <br /> ST-27 Back Pressure/TP 201.4 Tank Monitor Certification <br /> ST-30 PSI Decay USY TP 201.3 3-GPH Leak Simulation <br /> ST-37 Liquid Removal/TP 201.6 Static Tirque TP-201.1B <br /> ST-38 PSI Decay ASb TP 201.3B 0 Drop Tube/Drain Valve TP 201.1C <br /> ST-39 Air/Liquid/ TP 201.5 0 Drop Tube OVERFILL TP-201.1D <br /> REPAIR SCOPE (descnbecomponenetsandan(icipatediepairs) <br /> Notification Contact: Telephone: (925)551-4777 <br /> Scope of Work Contact: Telephone: <br /> r 4 L. ir. rra C. Hurt Crritc .I • niihi in r 0177 ., .. . .. n w rca _ innrc r . er c <br />