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j FU <br /> r�F <br /> WALTON _ _ <br /> P O Box 1025 9163721888 PH <br /> 3900 Commerce Drive 9163731172 FAX I <br /> West Sacramento,CA 95691-1025 CA Contractor's License#617238 <br /> Customer <br /> Job Location Work Order# 182761 <br /> Quik Stop Markets, Inc. Scheduled Date: 11/1/2024 <br /> 165 Flanders Rd Quik Stop Market#132 Z1 <br /> 3555 W. Hammer Lane Scheduled Time: 9:00:00AM <br /> Westborough,MA 01581 GVR Site ID 157402 Contact: Michael Karvelot <br /> Stockton,CA 95219 Customer PO# <br /> Phone: 2099513195 Facility: W31020-132 <br /> Station#: 132 <br /> Contract# <br /> Work To Be Performed: Call type: Test-Air Quality <br /> Annual Compliance Test <br /> Work Performed: <br /> 11/1/24 Performed Job Safety Analysis and uploaded JSA form to the Walton Work Order. <br /> 11/1/24 Replaced 87-1 fill swivel and nipple due to them causing a leak during drop tube test. <br /> Performed AQ Annual Compliance Test with passing results. <br /> x <br /> 1 <br /> Open Problems: <br /> E <br /> Parts Used: <br /> Qty Part# Mfg Mfg Part# New Serial# Desc Reason <br /> 1 301-13011 NW 161SALP-1020-EVR Swivel Adapter-Fill,EVR 7 i <br /> 1 301-11906 BLACKST 033005440 Nipple,4"x 6" <br /> t <br /> Date Technician I Arrival I Departure Date echnician Arrival Departure <br /> 11l1/24 Jauregui Jr.;Juan J. 8:40 1 13:00 11/1/24 Jensen; Matthew L. 8:40 13:00 ! <br /> i1 <br /> 1 <br /> Store Stamp&Signature <br /> Technician --gnattfre Customer Signature <br /> i <br />