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9255517899 Line 1 1047a.m. 01-06-2011 1/1 <br /> JAN 0 6 2011 { <br /> 6ETTLER - K^YANINC. <br /> 9VI8nnlw4UI;r ' <br /> PERMIT/SERVICE <br /> TESTING PROGRAM <br /> AGENCY NOTIFICATION SHEET W/O#: a,�3 CY3i <br /> Notification Date: Notification For: <br /> Requested Test Date: - Repairs ' <br /> Initial Test <br /> Facility Name: P&70 Re-Test <br /> Site Name Facility#: 5 <br /> Address: 4/ <br /> City,State: F/ <br /> Agency Notified: Method: <br /> Contact Person: Verbal <br /> Fax <br /> Telephone: <br /> E-Mail <br /> Fax.#: 0��'��j-f <br /> Testing Scope(check all components 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 Drop Tube/Overfill TP-201.1D <br /> TP-201.5/ST-39 Air/Liquid Secondary Containment <br /> Repair Scope <br /> Notification Contact: l�AAA b&W& Telephone: 925-551-4777 <br /> 6747 Sierra Court, Suite J - Dublin, CA 94568 - (925) 551-7555 - Fax (925) 551-7888 <br /> 3140 Gold 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 />