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Afforda-Te $t - Work Order Date' <br /> 416 2nd Street Galt, Ca 95632 Tech : <br /> 209 744-0112 <br /> Site : % Monitor ❑ Vpr Recovery Q Tanks/Lines <br /> Alarm Response / Lbr / Other <br /> Q Testing/ Rprs Passed l No Parts Needed Parts Replaced: Parts Needed: <br /> FRepairs Needed: <br /> Lid Bolts : OK 0 # Missing or Stripped F <br /> Site Representative (print): <br /> Results sent upon receipt ofpayment. Most regulatory agencies require <br /> results within 30 days of testing. Please plan your payment accordingly. Site Representative Signature <br /> *Any issues within a few days of testing could be related to this testing, so site must call us BEFORE maintenance repairs are done by others. <br /> m <br />