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• W.H. Breshears, Inc. Record of Computer Change, Meter Change, or Calibration General Const ion cD�'yion* Calif.Contractors NO.Q 41 `�� J1 1 COMPUTER CHANGE CALIBRATION f P.O.Box 392,Modesto,CA 95353 cusroMER• Ph. (209)5224""M NT4 "Itsvo- c.—a A O METER CHANGE I.�J L,h 4 h `... _ ADDRESS / S NATE PUMRMAKE AND MODEL SERIAL NUMBER CALIBRATION CHECKED MONEY ADJUSTED TO GALLONS FAST TOTALIZER FINISH _ I slow FAST slow READINGS MONEY 3 GALLONS TOTALIZER SEALED START METER SEALED YES ❑ NO ❑'VES ❑ NO PRODUCT GALLONS RETURENED TO STORAGE PUMP MAKE AND MODEL SERIAL NUMBER CALIBRATION MONEY CHECKED ADJUSTED TO TOTALIZER FINISH GALLONS FAST SLOW FAST slow READINGS I ' MONEY GALLONS START TOTALIZER SEALED METER SEALED 0 VES NO YES PRODUCT ❑ NO PRODUCT GALLONS RETURNED TO STORAGE PUMPMAKE AND MODEL SERIAL NUMBER CALIBRATION MONEY CHECKED ADJUSTED TO TOTALIZER FINISH GALLONS FAST SLOW FAST SLOW , READINGS MONEY START GALLONS TOTALIZER SEALED METER SEALED PRODUCT NO❑ NO ❑ YES ❑ NO GALLONS RETURNED TO STORAGE PUMPMAKEAND MODEL SERIAL NUMBER CALIBRATION MONEY CHECKED ADJUSTED TO TOTALIZER FINISH GALLONS FAST SLOW FAST SLOW READINGS MONEY START GALLONS TOTALIZER SEALEp METER SEALED PRODUCT .. [j YES ❑ NO ❑ YES ❑ NO GALLONS RETURNED TO STORAGE PUMP MAKE AND MODEL SERIAL NUMBER / CALIBRATION CHECKED MONEY GALLONS ADJUSTED TO TOTALIZER FINISH FAST SLOW FAST SLOW READINGS MONEY .05 GALLONS TOTALIZER SEALED START METER SEALED PRODUCT ❑ YES NO ]� VES ❑ No GALLONS RETURNED TO STORAGE PUMPMAKE AND MODEL SERIAL NUMBER CALIBRATION MONEY CHECKED ADJUSTED TO TOTALIZER FINISH GALLONS FAST SLOW FAST SLOW READINGS MONEY GALLONS TOTALIZER SEALED START METER SEALED O YES ❑ NO El YES ❑ NO PRODUCT GALLONS RETURNED TO STORAGE MAINTENANCE COMPANY CUSTOMER SIGNATURE W.H. Breshears, Inc. MAINTENANCE MAN'S SIGNATURE qND DEVICE REPAIRMAN NO.