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Elite IV Contractors Phone: (209) 461 -6337 <br /> 2535 Wigwam Dr. Fax: (209) 461-6342 <br /> Stockton, CA. 95205 P.O.# / Work Order# <br /> I LACE IN SERVICE NOTICE NOTICE OF SALE,LEASE,LOAN <br /> County Date Service Agency Registration No. <br /> 2278 <br /> LOCATION OF DEVICE <br /> Name of Customer Address City Zip <br /> 0� f f' /� <br /> 0 <br /> WEIGHING OR MEASURING DEVICES PLACED IN SERVICE <br /> Cert.of Conf.No. Out of Order Device <br /> Manufacturer Model Number Serial Number Device Type (if device is new Capacity <br /> Tag Number Location <br /> and marked) <br /> ��- ,b <br /> Remarks. <br /> -r G <br /> r / <br /> I 1 <br /> c,��1� �>'� ��•/j- C,rrl:1[.�1 C. � S�fG� ( `tri C.._��o <br /> ags enclosed if applicable Date placed in service <br /> Date this notice was: El Mailed <br /> ❑ Yes No(if no explain in remarks) � / / / ❑ Faxed <br /> Print Name of Service Agent Signature of Seryipe Agent Service Agent's License No. <br /> i <br />