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• , f <br /> TRIANGLE ENVIRONMENTAL, INC. <br /> SPILL BOX ANNUAL INSPECTION REPORT FO <br /> 1. FACILITY INFORMATION <br /> Facility Name: �h e dy') r7 Date of Testing: -Cgs <br /> Facility Address: ' _ MfWCNI L- <br /> Facility Contact: Y" Phone: (a da) L' 'rj 33 <br /> Date Local Agency Was Notified of Testing: }-a J , -03 <br /> Name of Local Agency inspector (if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Ronnie Humphries <br /> Triangle Environmental, Inc. <br /> 2525 West Burbank Blvd. <br /> Burbank, California 91505 <br /> (818) 840-7020, (818) 840-6929 FAX <br /> California Contractor License # 673971, A, C-10, HAZ, HIC <br /> 3. TEST RESULTS - DATA <br /> Test type <br /> Spill box/ Size Location Start End Hydrostatic Result <br /> Tank# Episode Product Box Mfr (gals) Fill/Vapor ime Time Or Visual P/F <br /> s <br /> Comments: <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements <br /> Technician's Signature:V -r- b Date:_ <br />