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11 <br />=I m2w, <br />Ll <br />4162 "d Street <br />Gait, CA 95632 <br />(209) 744-0113 Fax (209) 744-011 <br />E.O. VR -204 <br />Veeder-Root In -Station Diagnostics Site Shutdown Test Report Form <br />Permit Number: Date of Test: 12-18-13 Time: <br />Site Name: TRACY VALERO <br />Site Address: 2375 TRACY BLVD <br />City: TRACY CA Zip: Technician: DAVE WINKLER <br />Veeder-Root: B34975 <br />District: SJV <br />COMMENTS (include Description of Repairs Made) <br />I declare, under penalty of perjury under the laws of the state of California that based on information and belief formed <br />after reasonable inquiry, the statements and information provided in this document are true, accurate, and complete. <br />Signature of Technician: W Date: 12-18-13 <br />%; v"' t' i �? t �' e' i <br />