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9255517888 Line 1 0 :01 a.m. 11-04-2008 <br /> R L <br /> E C: <br /> 111042008 <br /> GE T TL ER INC. <br /> ff YA N SA <br /> ENVIRONMENTAL <br /> Izi HEALTH DEPARTMENT <br /> TESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/O#: <br /> Notification Date: Notification For: <br /> Requested Test Date: Initial Test <br /> Facility Name: Repairs <br /> Site Name Facility#: Ai-.Test- E:1 <br /> Address: /-Z, <br /> City,State. 017 <br /> A enc Notified: &zn4C_f exv Method: <br /> Contact Person: kaj,-1 tleln vFlar Verbal <br /> 7— Fox <br /> Telephone: 1-/zapy E-Mail <br /> Fax Confirm Date/Time: <br /> Tech: <br /> T <br /> Testing Scope tockacwjxw#n,,,hw&ppiy) <br /> ST-27 Back Pressure/TP 201.4 Tank Monitor Certification <br /> ST-30 PSI Decay USY TP 201.3 3-GPH Leak Simulation <br /> ST-37 Liquid Remcv8l/TP 201.6 Static T&rqu�p TP-201.1B <br /> ST-38 PSI Decay ASI TP 201.3B Drop Tube/Drain Valve TP 201.10 <br /> ST-39 Air/Liquid/ TP 201.5 Q Drop Tube OVERFILL TP-201.1D <br /> REPAIR SCOPE(descnbecampomnets ardanikoafedmpaks) <br /> Notification Contact: f2 Telephone: (925)551-4777 <br /> Scope of Work Contact: Telephone: <br /> L <br /> Sic rra Court . Siiitp J • Dublin r. a I if r% r m o 0 A 9 r, A . Ino r = 4 -7 cc r <br />