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Afforda-Te$t - Work Order Date ?- 1 ( 6 / ZL <br /> 416 2nd Street Galt,Ca 95632 Tech: <br /> 209 744-0112 <br /> Site: ! VC Monitor ❑ Vpr Recovery ❑ Tanks/Lines ❑ <br /> Alarm Respons Lbr/ ther <br /> 4 ? 5_0 cA /,. ,4 CoVe W 671u, <br /> ❑ Testing/Rprs Passed ❑ No Parts Needed Parts Replaced: Parts Needed: <br /> Repairs Needed: 11VS' a 4/rC /1 1:2(- a 1 QJ 7e__A ft✓1 C l <br /> 0 a'1 7 1 -�'—C G� �► �f �.4 �,cs��c <br /> Lid Bolts: OK ❑ #Missing or Stripped ❑ <br /> Site Representative(print): <br /> Results sent upon receipt of payment. Most regulatory agencies require <br /> results within 30 days of testing. Please plan your payment accordingly. Site Representative Signature: <br /> *Any issues within a few days of testing could be related to this testing,so site must call us BEFORE maintenance repairs are done by others. <br /> C <br />