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Record of Computer Change, Meter Change, or Calibration W.H. Breshears, Inc. General Construction Division Calif.Contractors No.456874 COMPUTER CHANGE CALIBRATION P.O. Box 392, Modesto,CA 95353 METER CHANGE W/M NOTIFIED � Ph.(209)522-7291 CUSTOMER ADDRESS Qh ,�. � GATE PUMPMAKE AND MODEL SERIAL NUMBER CALIBRATION Ch7 I CHECKED ADJUSTED TO MONEY GALLONS FAST SLOW FAST SLOW TOTALIZER FINISH �, L1 READINGS MONEY GALLONS TOTALIZER SEALED METER SEALED START a S S ' '� q S �] YES NO ..VES NO PRODUCT GALLONS RETURNED TO STORAGE �- Ier, J-j -'� "z y<, C7 ( PUMP MAKE AND MODEL SERIAL NUMBER CALIBRATION CHECKED ADJUSTEDTO MONEY GALLONS FAST SLOW FAST SLOW TOTALIZER FINISH READINGS MONEY GALLONS TOTALIZER SEALED METER SEALED START YES NO VES NO PRODUCT GALLONS RETURNED TO STORAGE PUMP MAKE AND MODEL SERIAL NUMBER CALIBRATION CHECKED ADJUSTEDTO MONEY GALLONS FAST SLOW FAST SLOW TOTALIZER FINISH READINGS MONEY GALLONS TOTALIZER SEALED METER SEALED START YES NO YES ❑ NO PRODUCT GALLONS RETURNED TO STORAGE PUMP MAKE AND MODEL SERIAL NUMBER CALIBRATION CHECKED ADJUSTED TO MONEY GALLONS FAST SLOW EAST SLOW TOTALIZER FINISH READINGS MONEY GALLONS TOTALIZER SEALED METER SEALED START YES L:j NO ❑ YES NO PRODUCT GALLONS RETURNED TO STORAGE PUMP MAKE AND MODEL SERIAL NUMBER CALIBRATION CHECKED ADJUSTED TO MONEY GALLONS FASLOW FAST SLOW TOTALIZER FINISH ST READINGS MONEY GALLONS TOTALIZER SEALED METER SEALED START YES ❑ NO YES NO PRODUCT GALLONS RETURNED TO STORAGE PUMP MAKE AND MODEL SERIAL NUMBER CALIBRATION CHECKED ADJUSTED TO MONEY GALLONS FAST SLOW FAST SLOW TOTALIZER FINISH READINGS MONEY GALLONS TOTALIZER SEALED METER SEALED START I ❑ YES ❑ NO YES 0 NO PRODUCT GALLONS RETURNED TO STORAGE MAINTENANCE COMPANY W.H. Breshears, Inc. CUSTOMER SIGNATURE MAINMNA14CE MAN S SIGNATURE AND DEVICE REPAIRMAN NO.