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F u. <br /> AF <br /> wALTON__ <br /> P.O. Box 1025 9163721888 PH <br /> 3900 Commerce Drive 9163731172 FAX <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 s <br /> 165 Flanders Rd Quik Stop Market#132 Z1 <br /> 3555 W. Hammer Lane Scheduled Time: 9:00:OOAM <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 Pe ormed: 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 /> 1 <br /> r: <br /> I <br /> Open Problems: <br /> i <br /> Parts Used: <br /> Qty Part# Mfg Mfg Part# New Serial# Desc Reason <br /> , r <br /> 1 301-13011 OPW 161SALP-1020-EVRSwivel Adapter-Fill, EVR 7 j <br /> 1 301-11906 BLACKST 033005440 Nipple,4"x 6" <br /> Date Technician Arrival Departure I Date echnician Arrival Departure <br /> 11/1124 Jauregui Jr-Juan J. 8:40 13:00 11/1124 Jensen; Matthew L. 8:40 13:00 <br /> �1 <br /> 4'': <br /> Store Stamp&Signature <br /> 1� <br /> Technician (gnat re Customer Signature <br /> l' <br />