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�����[i—�� � 416 2°a Street <br /> Galt, CA 95632 <br /> (209) 744-0113 Fax (209) 744-0116 <br /> E.O.VR-204 <br /> Veeder-Root In-Station Diagnostics Site Shutdown Test Report Form <br /> Permit Number: N-9259 Date of Test: 11-12-2019 Time: 1030 <br /> Site Name: ARCO STOCKTON <br /> Site Address: 6009 N EL DORADO ST <br /> City: STOCKTON, CA Zip: 95207 Technician: FELIX RAMIREZ <br /> Veeder-Root: B34976 <br /> District: SJVAP NORTH <br /> SITE SHUTDOWN TESTI <br /> Test Parameter Test Result(Y/N) <br /> Was power removed from the TLS-350 console? YES <br /> Was power to the submersible pump(s)removed by the TLS-350? YES <br /> Was power restored to TLS-350 console? YES <br /> COMMENTS (Include Description of Repairs Made) <br /> NOTES: lA certified Veeder-Root technician must perform this test. <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: Date: 11/12/2019 <br /> Ver. 1.0—09.18.08 <br />