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Facility #: #6020 p Contractor: B&T Service Station Contractors <br /> Address: 1711 E. Yosemite Address: 630 S. Frontage Rd. <br /> City,State: Manteca CA 0 City, State: Ni oma Ca 93436 <br /> Test Date: 2-120,12009 Phone: 805-929-8944 <br /> Type of test: I.Monitor Certification Impact Valve <br /> Yes No Technician: Aaron Shultz <br /> Test erformed during fine test? Testi n <br /> mpac ecure ave impactsecure Valve <br /> Disp# Grade Make Mount? Lock? Pass/Fail Comment Di sp# Grade Make Mount? Lock? Pass/Fail Comment <br /> t-� 87 v,.) <br /> -H 13 7 DPM <br /> (2214Z YY4o <br /> Is rb S7 p <br /> C\Documents and Settings\User\My Documents\Site Forms\Arco\Arco#6020 1711 E. Yosemite Manteca\Monitor Cert Forms\Impact Valve Testing <br />