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Pump and Alarm Verification Form <br />Site Address: I, % Ii2X S-t OVLC HIV t I I t <br />Company Name: yS �Yu't L�-�-s �,c. • License M <br />1. That a representative or I of my company has verified that the Indoor or Outdoor Pump Alarm <br />sounded by lifting the float switch and the alarm light is on and that the pump was tested with <br />the float switch. <br />2. If applicable, that myself or a representative of my company has verified that the Indoor or <br />Outdoor Filter Alarm sounded by lifting the float switch and the alarm light is on. <br />Date: Il�- Z3 Z <br />Print Name: F���1i..y L� �cc✓y� <br />Signed:, <br />Please upload to your permit in C-ifir�e�se��rvhen completed. <br />L%►�S Q� rl,�c;We.a`f'SLc,i¢-✓. C`,vl'Vl <br />Final Inspection and certificate of compliance cannot be issued until this form is received. <br />