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04/28/2005 THU 08:19 FAX <br />SB 989 TESTING PROGRAM <br />AGENCY NOTIFICATION SHEET <br />Notification Date: Notification For: <br />Test Dateliime: ! Q s / 700 Initial Test: <br />� � �� Repairs: <br />Fac#: t1 Re -test: <br />ddress: /• D �! Ly n Lh -7Cc <br />tate: C A- <br />encyName: u"'~ O!j �1 G w �fn- Notification Method: <br />erson Contacted: )O n-120 Fax <br />E-mail: <br />Verbal: <br />-fix Co o q) 4,; � � .5 <br />resting Comments <br />Testing will be performed on the date identified above to meet the SB 989 regulatory deadline. This notification <br />is being provided to most the 48 hour advance notice requirement_ Upon completion of testing, results will be <br />provided to your office as required. <br />ontractor Name:G� <br />Contractor Phone: C���� rDrO ` �� C) <br />Notification Made By; <br />(Name of Indi <br />Contact: phone: <br />Z001/002 <br />