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101 a.m. 01-22-2010 111 <br /> 9255517888 Line 1 a <br /> lbs<` <br /> JAN 2 2 2010 <br /> 6ETTLER - RYAN INC. <br /> ENVi i'D!VP:{=NTAL <br /> I1EAl:QI C{PA TMENT <br /> TESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/O d: <br /> Notification Date: ! O�� Notification For: <br /> Requested Test Date: Repairs <br /> Initial Test <br /> 1 <br /> Facility Name: Re-Test <br /> Site Name Facility#: <br /> Address: U <br /> City,State:( <br /> 4 9 / <br /> Agency Notified:' Method:/7 ��v <br /> Contact Person: Verbal <br /> Fax <br /> Telephone: <br /> E-Mail <br /> Fax#:C;;'7 <br /> Testing Scope (check allcomponents 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 C� Drop Tube/Overfill TP'-201-113 <br /> TP-201.5/ST-39 Air/Liquid r Secondary Containment <br /> Repair Scope <br /> _5Le <br /> �.i '! <br /> Notification Contact: �C(,.0 Telephone: 925-551-4777 <br /> 6747 Sierra Court, Suite J Dublin, CA 94568 • (925) 551-7555 • Fax (925) 551-7868 n_ <br /> 3140 Gold Camp 64 N. McDowrelll Blvd,eSui e•B2a• Petaluma, CA 94954 67( 707) 789-3255 30Fax (707) 789-3218 1 <br /> 170 ncho Cordova, CA 1 631-1317 ,YI✓l <br /> 1.� <br />