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Afforda-Te$t - Work Order Date <br /> 416 2nd Street Galt, Ca 95632 Tech: <br /> 209 744-0112 <br /> Site: va-ce`* Monitor ❑ Vpr Recovery ❑ Tanks/Lines ❑ <br /> -- ------ --- <br /> Alarm Response / Lbr/Other �-- <br /> 3 14 <br /> E] Testing/ Rprs Passed ❑ No Parts Needed Parts Replaced: Parts Needed: <br /> ❑ Repairs Needed: / <br /> i 6A <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 />