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fill II nCll III FAFII::Wllllrll. 11lll:AILlf11 ll If"II....ANINIING ANII.II..)II:Vll.11 )II"IMII IMII <br />'i/�d�hi�p� �y� rs •.RAG;:, __11 11)11::::Vll::::IlSa EA _i h.N"If .Y Vn'�al101M <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 he 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 Terhnictan.s with expired fwense spat/ not he <br />Permitted to perform Tests. <br />STArE OF CALIFMM)!-Yfr:AL <br />OSH-Ft]-OF'PJ';190 (q3/Ol!?nl �) <br />d!3C?OI4 <br />AND HUMAN SERVICES AGENCY <br />OPAA-+004 '1 (� <br />I:-ry: I I afy9 <br />