Laserfiche WebLink
rull 416 2"d Street <br /> norda— -$'AGalt, CA 95632 <br /> A�L101 (209) 744-0113 Fax (209) 744-0116 <br /> E.O.VR-204 <br /> Veeder-Root In-Station Diagnostics Site Shutdown Test Report Form <br /> Permit Number: N-945 Date of Test :7/26/18 Time: <br /> Site Name: WEST LANE FUELS <br /> Site Address: 3300 WEST LANE EMEM <br /> City: STOCKTON CA Zip: 95204 Technician: ED STEARNS <br /> Veeder-Root: #A31048 <br /> District: SJVAPCD VST: 3000490996 <br /> " <br /> Was power removed from the TLS-350 console? Y <br /> Was power to the submersible pump(s)removed by the TLS-350? Y <br /> Was power restored to TLS-350 console? Y <br /> is <br /> NOTES: 'A certified Veeder-Root technician must perform this test. <br /> declare, under penalty of perjury under the laws of the state of California that based on information and belief formed after reasonable inquiry, the statements and <br /> information provided in this document are true,accurate,and complete. <br /> Signature of Technician: Date: 7/26/18 RECEIVED <br /> AUG 15 2018 <br /> I�,NViiZONhIENTAL HEALT <br /> 1)I�.Pr�R"CI�iENT <br /> Ver. 1.0—09.18.08 <br />