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011::I•nCll. OF:: SIfAlfll yWllllrll. II1II.AILlfllll II..1II,,,,Ab114114I1lNG ANTI II,AII VII.II f..all"Ii�ll,:lh�tt <br />td� 11'A�CIIII 11Flll:S 11k1�:�6l�.Il..01F11yg11:Nr �D��V��"'b1101M <br />7 <br />TEST TECHNICIANS (Continued) <br />Provide Following Information for Each Test Technician Employed by the Agency (Attach <br />additional sheets if needed <br />`To update expiration date a renewal application for OPAA <br />and proof of renewal <br />for certification/license shall be required <br />Test Technician's <br />Name <br />Certification/ <br />License Type <br />Certification/ <br />Licensing Agency <br />Certification/ <br />License Number <br />Expiration Date' <br />Comments <br />Test Technicians with expired license shall not he <br />Permitted to pertotm Tests <br />S"fATE OF CALIFI M9--YiVN1 <br />OSFi-I-LD-r W AA- I qp (G/2-W'O I eS) <br />_VZ V >017 <br />AND HUMAN SERVICES AGENCY <br />0PAA r101 )-1b' <br />