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I <br /> LA <br /> P.O. BOX 1475 <br /> if UGHSOW CALIFORNIA 95326 <br /> (209) 537-6624 <br /> www.clarkssapticservke.com <br /> NAME DATE <br /> ADDRESS F (S <br /> PHONE r <br /> 4. <br /> SOLD BY CASH C.O.D. CHARGE ON ACCT. MDSE.RETC <br /> QTY. DESCRIPTION AMOUNT <br /> r <br /> Lam' �— <br /> i I <br /> C u <br /> tlAti� <br /> ' I <br /> ..........................._......... <br /> .'........ <br /> ......................... .......,.............................. <br /> ................ <br /> I <br /> I <br /> I <br /> y i <br /> II <br /> I <br /> , I <br /> TAX <br /> I <br /> RECEIVED BY <br /> TOTAL I <br /> All Claims and returned goods MUST bo accompambd by thin Wl <br />