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'ID <br /> 3 20.08 <br /> .. ........ ...... .... <br /> �4�V"1'r;i}(�iVZv—N'T 'anceDept. <br /> C?CQh,4;TlQF,P� TginnAve <br /> in <br /> San Jose,CA 95112 <br /> 408-213-6038-Office <br /> ..... ....... ........... <br /> . . . ......... . <br /> .... . ..... .. <br /> ......... ....... <br /> 408-213-6026—Fax <br /> AGENCY NOTIFICATION FORM DATE <br /> AGENCY: So-" c�A Civ xE �4 <br /> REQUIRED BY: C-La-wf-�Ls <br /> DATE: <br /> SITE INFORMATION <br /> SITE: c� I <br /> ADDRESS: al 0( cu �S C in CA <br /> REQUESTED INFORMATION <br /> SCOPE OF WORK ❑ TECHNICIAN CERTIFICATION <br /> ❑ PART SPECIFICATIONS ❑ WORK SCHEDULE <br /> ❑ TESTING RESULTS ❑ OTHER <br /> AS REQUIRED, PLEASE ACCEPT THE FOLLOWING (BELOW AND <br /> ATTACHED) AS OFFICIAL NOTIFICATION FOR THE REQUESTED <br /> INFORMATION ABOVE: <br /> I Lsiy�tu <br />