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10/20/14 03:32PM B2 Service Station Maintenance 916-572-1050 P.01 <br /> h <br /> ED <br /> ..._.............. ....... ...._..._._._._..__.....,.,....._..._............... <br /> . <br /> OCT 2 1 <br /> ------ <br /> ENV1R0NME,,q-rAL HEALTH <br /> B.Z. SERVICE STATION MAINTENA. i <br /> 1''1..IC)NE 91 d-:371-2380 FAX 916-57?-0150 <br /> Far or ento V LO rm back for cont rr7rta on OL amorrrttr ent <br /> I <br /> ( Atm- <br /> NVIRONMENTAL HEALTH (Monitor ertiflea tion) <br /> _.............. <br /> _...._.._..... ............ ..... ..... :.. . .. .. <br /> Alm. Sall Jtt<tcjttin Fm f le,11111 D,',,91k': i Y21' `01�4 <br /> Fax or <br /> A Nimiltor C•crtitf:ramill test has hrctl scheduled ill til [tO![t Nving location: <br /> Station 'dual: Lc.01„Food & [Liguor <br /> Station Address: 1223 1t'_l.mckfotrd Rd, Lodi <br /> Testing v'Nill be conducted on: Wedn sdw,_ Novcniber 1t),N 14 Nn itlnim,, at <br /> 7710.1611ott'il'g 14I.-i .y Will k'Colldf► .led(if applicable): <br /> lnvt:nlc�r� ctt'[�.clzti[�n�crlt �[�t.�llrc[rd.'c1•tiEict[ <br /> [...ine 1,.eak Detectors <br /> vacuum,"Pressure C't, cmitorirl�_' <br /> Spi3[ [3rlck-0 <br /> �: (.'t�n3[,littrtc:z: [cti! �_� ['tis! d;'c1rt;�trUct:lt'�fl ,lutht�rity _? <br /> I Klose col!firm Date rind 17'1111cr,Ph"rt-w-1 indiatle inspector nrrme below. <br /> 11'110 11l',Pet,'t01'crit vitt; 111ease Check � <br /> Please,m'11t1c.l 01(' 11711114'dialelY i .1,ml lt.611 lo i,t/11t't'l t11'1'G'-,5'c'17c'tl)11�,1, /lkmA 17111. <br /> O <br />