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9255517899 Line 1 OW7 a.m. 01-19-2011 1 /1 <br /> REC"'EIVED <br /> Ago . 1 <br /> -'AN 19 2011 <br /> &ETTLER — KYAN INC. MOBOblAdEWTAI Wrl <br /> ®t <br /> PER MIT/SERVI&b�_­ <br /> TEST-1 ROGRAM <br /> AGENCY NOTIFICATION SHEET W/O#: '5-?607U <br /> Notification Date: H+t k - Notification For: <br /> Requested Test Date: Repairs <br /> Initial Test <br /> Facility Name: Re-Test Z <br /> Site Name Facility M OM3 <br /> Address:3- LA2-'5 <br /> City,State:.. O'a <br /> Agency Notified: Method: <br /> Contact Person: Verbal <br /> Fax <br /> Telephone: <br /> E-Mail <br /> Fax#: 4_vA -La <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-201.0 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 /> OC3 LP -7 14 <br /> A . <br /> Notification Contact:ah%Lbf <br /> ,ZU1 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 62- Petaluma, CA 94954- (707) 789-3255 * Fax (707)789-3218 <br />