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9255517899 Line 1 40 <br /> C4:54 a.m. 12-10-2010 1 /1 <br /> GETTLER - RYAN INC. <br /> ITESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET <br /> Notification Date: — Notification For: <br /> Requested Test Date: o Repairs <br /> Initial Test ; <br /> Facility Name: Re-Test <br /> f ` <br /> Site Name \ Facili <br /> l ..�.. � <br /> Address: }— , <br /> n --.- <br /> i <br /> City, r Statej DEC 02010 <br /> ,� - <br /> COUNrY <br /> Agency Notified: ?_ 1 h'.?",_'jpII <br /> k+feiNHdEhrT' <br /> Contact Person: �' - '� Verbal <br /> Fax <br /> Telephone <br /> r�� ' _ ) E-Mail <br /> Fax#: p� ( <br /> Testing Scope(check all components that apply) <br /> TP-201.4/ST-27 Back Pressure Tank Monitor Cert/Bucket Test <br /> TP-201.3/ST-30 PSI Decay 3-GPH Simulation <br /> TP-201.6/ST-37 Liquid Removal TP-201.18 Static Torque <br /> TP-201.3B/ST-38 PSI Decay AST Drop Tube/Overfill TP-201,2D L� <br /> TP-201.5/Si-39 Air/Liquid Secondary Containment j <br /> Repair Scope <br /> Notification Contact: !r Telephone: 925-551-4777 <br /> 6747 Sierra Court, Suite J a Dublin, CA 94568 a (925) 551-7555.• Fax (925) 551-7888 <br /> 3140 Gold Camp Drive, Suite 170 • Rancho Cordova, CA 95670 • (916) 631-1300 • Fax (916) 631-1317 <br /> 1364 N. McDowell Blvd., Suite B2 • Petaluma, CA 94954 a (707) 789.3255 • Fax (707) 789-3218 n V <br /> n` <br />