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beishiore <br /> 2Foot Towne Centre Drive <br /> Foothill Ranch,CA 92610 <br /> environmental services,inc. (949)460-5200 <br /> BELSHIRE TESTING &COMPLIANCE SERVICES <br /> WORK ORDER <br /> Site: Job Number: Date: <br /> Costco - Stockton 25739 06/21/2022 <br /> Address: 1616 East Hammer Lane city: Stockton Truck: <br /> ■❑Secondary Containment ❑Monitor Certification ❑Vapor Recovery Test ❑Repairs ❑Maintenance ❑Inspection/Other <br /> Inspector Name: Job Status: ❑completed <br /> *No Inspector on Site ❑Return Trip Needed <br /> Services Performed: <br /> On site to conduct Secondary Containment Testing <br /> Test Water Status: <br /> ❑None Generated ❑■ Placed in Tank Trailer ❑Placed in Totes ❑Placed in Existing Drum ❑Provided Drum <br /> Arrival: 7:OOam Departure: 12:OOpm Time on (Less Meals):4.5hrs Number of Personnel:3 <br /> Moises Burciaga <br /> Te ian Name Site Representative/Facility Manager Name <br /> Technician Signature ite Representativ6'/Pfcilityanager Signature <br />