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FROM : WIGHT ENTERPRISES FAX NO. : 209 466 2201 Apr. 30 2002 12:16PM P2 <br />AMEX TRANS# <br />Ni ARCO PRODUCTS COMPANY <br />E H&S .INSPECTION PROGRAM <br />WORK ACItNOWI.,Ell(.MRN'1' <br />VENDOR NAME _U C.C? �� DATE 7 <br />ADDRESS -I u AUTH# <br />CITY, STATE in �.in VC', FACILITY#�. �I <br />LOCATION <br />r t�; I i►.��_T <br />1C 9 C. <br />SERVICE REQUESTED (CHECK) <br />TANKILINE TIGHTNESS TEST FACILITY INSPECTION ❑ <br />VAPOR RECOVERY TEST ❑ ENVIRONMENTAL REPAIRS ❑ <br />QTHER ❑ <br />SERVICES PERFORMED (REPAIRS ONLY__E'r-t t NUrig �l <br />MB ER OF PERSONNEL—t. TOTAL TRAVF.T. TTME I_LESS MEAL TIME <br />CHECK IN <br />ARRIVALS AS OF CHECK IN <br />PRINTED NAME OF DEALER <br />OR STORE EMPLOYEE <br />DATE <br />S GNATURE Ol- DEALER OR STOK ' i NIP/L(�OYEE <br />CHECK OUT <br />DEPAR'T'URES AS OF CHECK OUT ` (M>M <br />PRINTED NAME OF DEALER <br />OR STORL EMPLOYEE <br />5ICNA)` M. OF DEALER OR STORE PLOYEE <br />DATE <br />SI(yNATI1RE AT DEALER (OR STORK MANAGER) DOES NOT OBLIGATE DEALER IN ANY WAY, NOIR D0 ES 3(T <br />SA(;N)BY ANY APPROVAL OF WORK DONE. CONTRA(7'r0R.I`3 RESPONSIBLY FOR FILLING OUT 'PHIS FORN.I . <br />AND OISTA.INTNG MGNATURF. <br />i 1 <br />LOCATION COPY <br />w..__. <br />