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92555178ft Line 1 <br />0 : 23 a. m. 01-09-2009 1 ! 1 <br />op <br />GETTLER-HYA" INC. JAN 0 9 2009 <br />•'. ..e i •, �t Y <br />HEALTH L:EF,4-',c MENT <br />TESTING <br />AGENCY NOTIFICATION SHEET <br />WIO : <br />Gj j <br />Notification Date: <br />Notification For <br />Re nested Test Date: �'�j <br />j� iY j " (e0- �e � <br />Initial Test <br />Facility Name: <br />Repairs <br />Site Name <br />Facility!---4�9 <br />Re -Test <br />Address: 4?60& <br />Q <br />Ci!j' State: X. 7l 46 <br />A ency Notified: Ido, <br />7''7 <br />Method: <br />Contact Person: <br />Verbal <br />Fax <br />Telephone: <br />E -Mail <br />/ <br />Fax M: (l1l� ' 3 <br />Confirm Date/ Time: <br />Tech: <br />Testing Scope w*ck,ucon,,w,nr,sn,t,P*) <br />ST -27 Back Pressure/TP 201.4 <br />Tank Monitor Certification <br />ST -30 PSI Decay UST' TP 201.3 <br />3-GPH Leak Simulation <br />ST -37 Liquid Remcvsl/TP 201.6 <br />Static Tir' que TP -201.1B <br />ST -36 PSI Decay ASY TP 201.3B <br />Drop Tube/Drain Valve <br />TP 201.1G <br />Eq <br />ST -39 Air/Liquid / TF 201.5 <br />Drop Tube OVERFILL TP -201.1D <br />REPAIR SCOPE (descfibecomgoneneisandant aree&-R,Ns) <br />/tel <br />Notification Contact: <br />Scope of Work Contact: <br />Z <br />Telephone: (925) 551-4777 <br />I •t- Sierra Court- Burne J D"ubrin. Califarrvi 44 -Koff w t4gg1 1; 9;1_'G.99 <br />