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9255517888 Line 1 :00 P.M. 11-02-2009 <br /> 1 /1 <br /> UETT�R ,,­-KYAN INC7611 <br /> !TESTING PROGRAM NUV 0 2 2009 <br /> AGENCY NOTIFICATION SHEET 842 J0"';".`j <br /> Niy Wo#:4tl <br /> Notification Date: k 09 t-1 Notification For: <br /> Requested Test Date: Ll IQ Rl-rn Repairs <br /> Initial Test <br /> Facility Name: Re-Test <br /> Site NameC�nn QR'�Rfiae'(�Lwirlty M <br /> Address; L[ UA_[0 U U� <br /> City,State: qyy Ann 0— A <br /> Agency Notified:� Method: <br /> Contact Person: Verbal <br /> Fax <br /> Telephone: <br /> Fax#: Q1 4EPULI V <br /> E-Mail <br /> Testing Scope (check all components that apply) <br /> rP-201.4/57-27 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-201.113 Static Torque <br /> TP-201.3B/.ST-38 PSI Decay AST Drop Tube/overfill TP-201.1D <br /> TP-201.5/57-39 Air/Liquid Secondary Containment <br /> Repair Scope <br /> INotification Contact: OUVW 0AXIaLk Telephone: 925-551.-4777 <br /> 6747 Sierra Court, Suite J - Dublin, CA 94568 - (925) 551-7555 - Fax (925) 551-7888 ltl <br /> 3140 Goll 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 - (707) 789-3255 - Fax (707) 789-3218 <br />