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Placed ini Service Deport <br /> for Commercial Weighing or Measuring Devices <br /> Registered Service Agency Location of Device <br /> "Name 'Company <br /> A4 � Ic, v c` l A; e rc <br /> L ;� e' �"� . LLL i Name <br /> *Address - l � r ,L� ! ; l 'Address Lcsxhro � � �� <br /> c1T <br /> *City. 'city <br /> State, Zip c' w, S F; `{ state , Zip SCJ <br /> Phone { I `-� ) `7 {1 - � (� *County <br /> *Agent �c �c� ra I, - = "Date of <br /> Name eke : lid Repair orI ' AL <br /> Placing r J <br /> License # 3 ; LA & into <br /> Service <br /> Device information <br /> 'Device <br /> ID =*SerialNumber <br /> e pu�P "Device *Model Type of Device <br /> orchackManufacturer Number (capacltylfappllcable) <br /> stand # <br /> Rem s : <br /> xt:. llt� <br /> REQUIRED JNFORdW7)ON Rbfurnnoo Call bmla Code C/ Rogutaticns, 7Nlo 4, flJv/3lon 0, C1t�ptar4, Secdon 4085 rs) <br /> Link to county contact information; <br /> http:!/www.cdfa ca . Qov/exec/county/documents/countvcommissionerseaiercontactinfo pdf <br />