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RECEIVED <br /> JUN 19 2014 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> Afforda-Te$t - Work Order j Date r <br /> 416 2nd Street Galt,Ca 95632 Tech: , <br /> 209 744-0112 <br /> Site: , 42( f Monitor 1pr Recovery ® Tanks/Lines <br /> AiarnVs ns'U& br/Other <br /> Testing/Rprs Passed Q No Parts Needed Parts Replaced: Parts Needed: <br /> QRepairs.Needed: <br /> e <br /> Lid Bolts: OK Q #Missing or Stripped M ; t <br /> Site Represen tiv (print),! r r'+AL <br /> Results sent upon receipt of payment. Most regulatory agencies req iret''` c <br /> results within 30 days of testing. Please plan your payment accordi igly. Site RepreseV9, ignature: <br /> *Any issues within a few days of testing could be related to this testing,s site must call us BEFORE maintenance repairs are done by others. <br />