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0 <br />TRIANGLE ENVIRONMENTAL, INC. <br />SPILL BOX ANNUAL INSPECTION REPORT FORM, <br />1. FACILITY INFORMATION , <br />Facility Name: (�; ; (Q <br />Date of Testing: G Q5.1 6 L <br />Facility Address: .r LY1i' <br />Facility Contact: C,. h e I- <br />Phone: <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency inspector (if present during testing): r <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 />..Size <br />. ..- - .. :.(gals) -,...Time <br />Location <br />Start. <br />.. <br />• <br />-- <br />rl <br />i <br />p. <br />�0 m <br />00 � V WAN <br />BMW] <br />i <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: 'Vx� � r.^�,�VY�/ Date:_ CD- 0t) <br />