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Ll <br />11 <br />4162 "d Street <br />Galt, CA 95632 <br />(209) 744-0113 Fax (209) ..,,1 0 <br />E.O. VR -204 <br />eerier- oot -Station Diagnostics Site Shutdown Test Report For <br />Permit Number: N30-1-7 Conf# 17-23630 Date of Test: 5-8-17 <br />Site Name: SHOP N GO <br />Site Address: 4511 PACIFIC AVE <br />Ci STOCKTON CA Zip: 95207 Technician: DAVE WINKLER <br />District: SNi <br />Veeder-Root: B34975 <br />c <br />Test Far <br />Was power removed from the TLS -350 console? <br />Was power to the submersible pump(s) removed t <br />Was power restored to TLS -350 console? <br />ATE SHUTDOWN TESTI <br />meter Test Result (Y/N) <br />YES <br />the TLS -350? YES <br />YES <br />NOTES: 'A certified Veeder-Root technician must perform this test. <br />I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed <br />after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. <br />Signature of Technician: . <br />