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r If <br />AR. M,04ROLP.O. BOX 50^ wrak Orders <br />>E Vacaville, CA 9565. .,07 <br />28587 <br />r _ E (707) 437-6668 (916) 441-2886 sales orders -7s,17— S' Z <br />., <br />UM <br />TOLL FREE: 1 (888) 2ARMOUR Customw P <br />for l (888) 227-66871 <br />Site Name: <br />General Contractor's Lick 498721 Stat ens Page <br />; ISite Address: SW(P 2--Z. <br />�• ��--yy�� <br />(40's � �YV� (Q,� � ❑ COD YJ Charge <br />Cit! ` L Sita Phonek Was Job Completed? <br />J iV PPE Required (Check all that applyand/or fill-in "other" blank space Yes ❑ No <br />Safety Vest ❑Hard Hat Steel -Toe Boots Safety Glasses/Goggles Job UpdatedlCiosed with <br />Protective Clothing ZGlovas ❑ Hearing Protection arricades/Tape Customer', <br />ntractor W discussed job and safety of job with me U Other ❑Updated q Closed <br />Service carni Site Rapaserdalive's signature JSA Refarenrea' Was blue made? <br />❑Yes <br />Contractor to com a action below If circumstances on site ors ecific to this ob ma aerate additional hazards not described in the JSA <br />How to Reduce or Eliminate Risk <br />Task Stop Hazards Not Covered by JSA include extra PPE to be worn <br />Wank documentation requirements MaterialslRentals Used: <br />Lower Risk• mis Esrey may be used as JSA Part# Description Q Price Amount <br />Medium Ri.10K w, Risk -JSA Req'd /y Q� O <br />fG� Risk. JSA Rewired and other ouitaner requiremma <br />ents y apply� �'m P/'7 /0 lJf <br />Reported Problem: Ver 1 i <br />a'I iA, <br />trek:5�.r ' United Pacific <br />Ston# 5446 <br />Services/Repairs Performed: 1403 Country Club BIVd <br />A, rirw-e� C -0--i Stockton, CA 95204 <br />209.843.2082 <br />re��cGeel %e�! l�•s <br />`%Y Total Material $ <br />r0i% 5 A�j �' i - Sales Tax on Total Material $ <br />Vv! <br />1I W Tlf/I Rental Description Price Amount <br />�V13tura / 71QSf �vr' / �► <br />Total Rentals $ <br />Labor/Travel Charges: <br />Departure Labor Labor & <br />Tech Name Arrival Time Time Hours Travel Hours Total Hours Travel Rate Amount <br />13ro a `r i `l <br />Terms: Please ,rote that some reported problems due <br />to defective equipment or intermittent problems not <br />present or which cannot be duplicated when our <br />Service Technician is on site, may not always be <br />resolved In one trip. Total Labor/Travel Charges $ <br />h is the customer's responsibility to verify information Mileage Rate Amount <br />is accurate on this work order prior to signing form. <br />A finance charge of 1112% per month, which is an annual percentage rate of 18•x, is charged on all past due accounts. Freight <br />prepaid by seller does not include any "carte coverage"which is the responsibility of the buyer to purchase if needed. In the Total Mileage Charge $ <br />event of efforts or legal proceedings to enforce Me collection of such sums due herein, customer agrees to pay reasonable <br />attorney's fees. TOTAL INVOICE... $ <br />1 undsrwwd & aeras Ia an [amts d corra87ans"ouainsd on Ws work order. <br />Service Tech. Sorwce Toch,ican (Pim Name) kr'rpz)wet*ro <br />Prson (Print Name) <br />lie Techni n's er tura Service Technician's Signage PersDate�EASEPAYBYINVOICECheck us out online at wwwal m.net <br />ORIGINAL - OFFICE COPY YELLOW - CUSTOMER COPY PINK - TO REMAIN IN BOOK <br />