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9255517899 Line 10 03 a.m. 11-05-2010 1 /1 <br /> VETT ER - fTYAN INC <br /> TESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/o#: u W <br /> Notification Date: 11-6- 10 Notification For: <br /> Requested Test Date: /a - 7- Repairs <br /> y��;n` Initial Test <br /> Facility Name: ' y Re-Test <br /> Site NameO Wez Facility#: <br /> 11 Is > <br /> Address: '7N Q dkl- PSS F <br /> City,State: <br /> �•� e&n NOV 05 '201A <br /> SAN JOAOUaJ COUNTY <br /> Agency Notified: n Method: HEALTH DEPARTA,IENT <br /> Contact Person: ,s.7 2^ Verbal IJ <br /> Fax <br /> Telephone: <br /> L, /n <br /> Fax.#: c26 7(�9/ 3` 3.3 E-Mail <br /> Testing Scope (check all components that apply) <br /> TP-201.4/ST-27 Back Pressure Tank Monitor Cert/Bucket Test o <br /> TP-201.3/ST-30 PSI Decay 3-GPH Simulation L� <br /> TP-201.6/ST-37 Liquid Removal TP-201.16.Static Torque <br /> TP-201.3B/ST-38 PSI Decay AST Drop Tube/Overfill TP-201.1D <br /> TP-201.5/ST-39 Air/Liquid Secondary Containment <br /> Repair Scope daze, <br /> nom/- <br /> , / / ! 1 / !' <br /> Notification Contact: Telephone: 925-551-4777 <br /> 6747 Sierra Court, Suite J • Dublin, CA 94568 • (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 82 • Petaluma, CA 94954 • (707) 789-3255 • Fax (707) 789-3218 <br />