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Afforda-Te$t Spill Bucket <br />416 2nd Street 0►744-0112 <br />Test Report <br />Galt, Ca. 95632 FAX 209 744-0116 <br />1. FACILITY INFORMATION <br />Facility Name: Date of Testing:() -7113166 <br />Facility Address: (o {� S �D G% ��1 0 .f ` 2 <br />0 2 <br />Facility Contact: G ' Phone: 2- �� qq - 11036 <br />Date Local Agency Was Notified of Testing <br />Name of Local Agency Inspector (ifpresent during testing): n! <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: P}0 -%,>Z4-[ <br />Technician Conducting Test: Z p rJE N i VV1 O <br />Credentialsl: ❑ CSLB Contractor ICC Service Tech. SW-4CI3janjc Tester ❑ Other <br />License Number(s): 0 <br />.............. �. — (.r«&""U gryurrnuscun un repairs maae prior ro resung, ana recommended follow-up for failed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify. that all the information. contained inthis report is true, accurate, and in full compliance with. legal r quirements. <br />Technician's Signa Date:15 <br />