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FROM : WIGHT ENTERPRISES FAX NO. : 209 466 2201 Jun. 06 2002 08:50AM P4 <br />ARCO Products Company 1i . WORK <br />C NOWLEDGMENT <br />Belshire Envirorlxnentai Services, Inc. I- BFQNT \r <br />VENDOR NAME <br />r 25422 Tt-abuco Road. 41 QS -269` • <br />ADDRESS <br />Lake Forest <br />CITY <br />STATE, ZIP CODE <br />SERVICE REQUESTED, _ <br />B <br />Jf <br />CA 92,630 <br />i ru-n�tr, 380cc <br />DATE. <br />546<_3 encu <br />FACILITI; _ AUTH #/JOB ORDER;_„ P k(' <br />I30 South Wilson Way <br />LOCATION: _._.. <br />Stockton <br />is, reque-sted to retxzovo I dn-,m(s) of waste containixzg petroleum hyrirc�arbons <br />SERVICES ACTUALLY PERFORMED: rf$e n-fify the number Of dliums removed from the site <br />Absorbent/Crasoiine ,•:.r•..: '... <br />Filter :1.:.zmS: <br />CA <br />FACILITY STAMP <br />❑ MAINTENANCE VENDOR (Attach white copy to invoice and mail to technician.) <br />❑ LIGHTING <br />❑ LANDSCAPING / FL60R I PEST CONTROL VENDOR <br />❑ FIXED COST (Dispensers, General Contractor, Signage) <br />TOTAL ///0 ,/ g <br />PRINTED NAME OF DEALER � � �.� � � � / d <br />'OR $TORE MANAGER/EMPLOYEE:. DATE: f <br />SIGNATURE OF DEALER �` J <br />OR STORE .MANAGER/EMPLOYEE: <br />SIGNATURE OF DEALER (OR STORE MANAGER) DdES NOT OBLIGATE DEALER IN Abli WAY; NOR DOES IT SIGNIFY ANY APWROVAL.`OF WOkk. <br />DONE: CONTRACTOR IS RESPONSIBLE FOR FILLING OUT THIS FORM AND OBTAINING SIGNATURE. <br />