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AFFORDA-TE$T <br />416 2nd Street <br />(209) 744-0112 <br />Gait CA 95632 <br />(209) 744-0116 FAX <br />Spill Bucket <br />Test Report <br />TEST DATE, <br />SITE NAME ZZ <br />L PHONE ( ) <br />ADDRESS ejoclT'C2L0Q <br />CONTACT: ,qv <br />Inspector: o a e " AW1 <br />resent / Not Present <br />Test Water: Taken with tester ZLeft on-site <br />hereby certify that all the information contained in this report is true, <br />accurate, and in full cont lianc with legal requirements. Technician;, Zane A. Nimmo <br />ICC #: 5263322 -UT <br />Signature OTTL #: - 04-1676 <br />