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RECEIVED
<br />WALTON MAY u 7 2020
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<br />P. 0: Box 1025
<br />3900 Commerce Drive ENVIRONMENTAL HEALTH 9163721888 PH
<br />8163731172 FAX
<br />West Sacramento, CA 95691-1025 DEPARTMENT CA Contractor's License # 617238
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<br />1 309-51011
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<br />Quik Stop Markets, Inc.......
<br />Quik Stop Market #125 Z1
<br />Scheduled Date:
<br />6/4/2019
<br />4567 Enterprise Street
<br />ACCU MHZWCA
<br />Fremont, CA 94538
<br />1580 W, Main Street
<br />Scheduled Time:
<br />9:00:O0AM
<br />S .D, to
<br />12 i'A; .I:,r,
<br />Ripon, CA 95366
<br />Contact:
<br />Michael Karvelot
<br />08:45 15:15
<br />614119
<br />Customer PO# :
<br />C-1-0001
<br />Phone: 2095994261
<br />Facility:
<br />W31020-125
<br />Station # :
<br />125
<br />Contract #
<br />Annual Compliance Test
<br />614119 JSA Completed,
<br />614119 Performed annual monitoring certification with passing results. SJVEHD County inspector was onsite to observe testing. All test water was
<br />placed in onsite hazdrum ASD 3-27-19 that is 414 full and another Walton supplied drum ASD 6-4-2019 and is half full.
<br />Removed a small amount of liquid from the diesel stp sump.
<br />Removed approx 5 gal of liquid from the 87 and 91 fill sumps.
<br />Removed approx 85 pal of liauld from the diesel fill sumi).
<br />Store Stamp & Signature
<br />Technician Signature J Customer Signature
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<br />1 309-51011
<br />R1=81 DRUM, 55 GAL.,
<br />DOT
<br />Drum, 55 Gal. DOT, UN1A2, Open Top
<br />1 309-72090#
<br />ACCU MHZWCA
<br />Label, Hazardous Waste Decal for Drums
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<br />51191 er.8ta1311! ;;
<br />614119 Olvera III; Henry S.
<br />08:45 15:15
<br />614119
<br />Reyes; Anthony F;L 08:45
<br />15:15
<br />Store Stamp & Signature
<br />Technician Signature J Customer Signature
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