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SWRCB, Janx <br />y206t6 <br />Opffl BucketTestingReport Fox <br />This farm is intended far use by c wractors performing annual'teWng of W xpil! contastructuress.. The c:ompleded farm andl <br />printouts from tests (f applicable:. ; hould be provided, to the facility ownerloperator farinment submittal to the local regulatory.agancy. <br />ity Naxne: `3 P w, -LS 1 Date of Testing: PU .. b� <br />ity Address: `t 4t 1 0. <br />"!�e •�dQ C ";'._ . �' <br />ityContact p d ,,, _ L;, Phone: c • <br />Local Agency Was Notiified N.-esting : • ?tom. <br />of Local Agency Inspector , rj-,resent during teswa---- <br />2, rIDSMG. CO <br />Cau )any Naane: ey <br />T clan Conducting Test: <br />Credentials'.- Q CSLB Contracts Service Tech. <br />L' c Number(s): 110 t . ") ` c <br />3. S B <br />TCA MeiTxod Used Hydrostatic <br />.. <br />Test Used: -1t,1t i4-,-6. <br />Fi u4 Reading X): <br />Test'Dm2tion ( F — TO: <br />!Cha4geinReading (RF -R3): <br />EE <br />NUM -7-61 I <br />i►1" a Yi i <br />-- A .,:w t <br />NOV.2014 <br />A <br />cERTmrATION Ili' TECEMCUN RESPONSIBLE FORCONDUCTING, TESTING <br />I hereby. certify chat al[the. fufore: �Z `.ions. coWain'eed in.this. report is true,. accurate, and in fuJ courpGauc c a tthi legal requir <br />Date: <br />Tocbmdeiin'sSignaturez <br />i State laws and regulations do not c ra cantly require testing to i by a ed . lEi®wevet; icpcai re t <br />may be more stringent: <br />6-d 2i►6919i►60a T s.ao40eW03 Al aI T 13 e66:11 i• t 60 n®N <br />