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TRANGLIE ENVIRONMENTAL9*C. <br />SPILL BOX ANNUAL INSPECTION REPORT FORM <br />1. 0'-1 r\ <br />Facility Name; J)vloyj 'A Date of Testing: <br />Facility Address: (Qq 1E, A r 1-Y), <br />FacilityContact: Phone: <br />C7w h eY- <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency inspector (if present during testing): Y) <br />, f <br />2. TESTING CONTRACTOR INFORMATION <br />Ronnie Humphries <br />Triangle. Environmental, Inc. <br />2525 West Burbank Blvd. <br />Burbank, California 91505 <br />(818) 840-7020, (818) 840-6929 FAX <br />California Contractor License # 673971, A, C-10, HAZ, HIC <br />3. TEST RESULTS - DATA <br />Spill box/ <br />Tank # 0 M. <br />Location <br />0 <br />Ali-�--_ <br />�_-■_ <br />Comments: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: VK� �^ Date: <br />