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A'w[IEIK;I9I <br />lynamic Back Pressure Test Report Form <br />Permit Number: Test Company: BZ SERVICE STATION MAINT <br />Site Name: ECONO GAS Technician: ED STEARNS <br />Site Address: 880 VICTOR ROAD Certification Number Expiration mate <br />City: LODI Zip: District: <br />Date/Time of Test: 8-10-09 13OPM <br />NOZOO <br />Fuel <br />20 CFH <br />60 CFH <br />80 CFH <br />100 CFH <br />Number <br />tirade <br />112 <br />ALL <br />•04 <br />314 <br />ALL <br />•04 <br />816 <br />ALL <br />.05 <br />718 <br />ALL <br />.04 <br />1 declare, under penalty of perjury under the laws of the state of Califomis that based on information and belief <br />formed after reasonable inquiry, the statements and information provided in the document are true, accurate, <br />and complete. <br />Signature of Technician: ._,.� Date: <br />Soon NQI,LV,LS HOIAHHS ZS 08£Z TLC 9T6 XVd £T:OT OTOZ/90/TO <br />