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i <br /> SERVICE/REPAIR AUTHORIZATION <br /> o ®fnl�Q�G <br /> L;1- I0O m mil° CGT co' <br /> CALIFORNIA CONTRACTOR LICENSE 30910SA-C$N060 HA2 <br /> j 108 N.UNION ST.STOCKTON.CALIF.95305 <br /> P.O.BOX 508 STOCKTON.CALIF.45301 <br /> PHONE 204/414.9337 <br /> SALES SERViC£ + INSTALLATION OF PETROLEUM DISPENSING • LUSPICATIOH&INDUSTAIALSERYICEEQUIPMENT <br /> DATE <br /> P.C .q �.. 5J; <br /> L <br /> AUTHORIZING NAME COMPAN NAME <br /> im <br /> BUSINESS ADDRESS ST. <br /> LOCATION <br /> { CITY ZIP PHONE <br /> E <br /> I <br /> AUTHORIZED REPAIR OF THE FOLLOWING EQUIPM€NT <br /> • <br /> OMPANY <br /> b IER�E�1'�6"-oRjz_Uur.REP'kRFSEFIVICE WORK TO BE DONE BY STOCKTON STATION <br /> i <br /> �? Gly r° �,`� .� ) `2�-"'✓� <br /> I <br /> _ I <br /> I <br /> � 9 <br /> I <br /> I <br /> ' f <br /> IPMENTC <br /> INC.A9 ESiDRIBEE'IYABOVE ON THE EQUIPMENT NAMED HEREON.ALL REPAIR PARTS ARE TO BEuBILLLED AT S.S&E <br /> REGULAR.P1110ES.I AGREE TO PAY CASH FOR SUCH REPAIR PARTS AND LABOR ON DELIVERY OF EQUIPMENT OR ON <br /> TERMS SATISFACTORY TO S.S.S.E.AND UNTIL PAID IN FULL ANY UNPAID BALANCES SHALL CONSTITUTE A LIEN ON THIS <br /> EQUIPMENT'.I FURTHER AGREE THAT S.S.S.E.WILL NOT BE HELD RESPONSIBLE FOR LOSS OR DAMAGE TO SAID <br /> :EQUIPMENT FROM FIRE,THEFT OR OTHER CAUSES BEYOND S.S.S.E'S CONTROL: <br /> I AGREE TO BE INVLIIC D NOWILLS SUBJECT TO TERMS. <br /> AUTHORI 0 SIGNATURE TITLE <br /> X" . .. <br /> FORM 0 0415 <br /> CUSTONIER COPY <br />