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3887 N.Valentine Ave.* Fresno,CA 93722 *(559)444.1730 CA Billable <br /> I � Factory Warr. <br /> �; License No.779267*AN EMPLOYEE OWNED COMPANY IE= COD <br /> Please Visit Our Website: wwwAcseryices.ccm Not Billable <br /> 7ETROLEUM MAINTENANCE CO, <br /> t FRESNO,CA IO Bid Job <br /> Name: <br /> SR I I' 128000 - <br /> Address:— <br /> Ass:_ ?72 Al /ez <br /> Addre _// � t/�d Dale: <br /> City: � �� Zip: Phone: Work ordor# A29V <br /> Dispenser Mak eQ cust.P.o# LN <br /> Dispenser Model: Close confr.# ss,,,, <br /> Dispenser Serial #: Purchase Order#.c1 W <br /> Pump Test: Gallons: Af DollarAmt:14 <br /> D scription of Work Performed <br /> i <br /> toot. eii <br /> 1, give authorization to LC Services <br /> Signature & Date Print Name <br /> to run my credit card as form of payment. <br /> bee WH be responobls for aTi bookpespl ea it ray ettwnt is stressed to a bid pat,for mdecfmns.Si wit ba wnnrented <br /> in.nlorw sny of lire bmu of this.'swen prover rely slut be m0lbd b reamnsble 91honeyt feet ami the Cont ofNri tin <br /> .hall be inhste sweet)m Foams County aha grad to yet or any assignee the right to vef"WIernent or rM a credlreporl b card#: <br /> a..snrymr.mut,bwgdnyItanna,d gafmnbli:es,nowt. <br /> Card Type: Billing Zip: ' <br /> If mmnuMoese by^.is wonsi,she,pant loohnion to yew,ofik..or soon ani to amtedowes by pho 11IMa ars <br /> on aaists,,grid a onef ing detes in operanf..arnotes,mar be Mn pi a nam and phone reenter. Exp Date:_/ / 3 Digit Seen rity Code: <br /> Wks sperms prarid'mgbylone.the the aG Street.)M1enhy sane ythelame,of wei either vyr.ssedw implied•hood', Name on Card: <br /> my Yriplied wfant,or nrerdunWbJfry of Non be a pontoon pi.pose,and sebw eewmes m auffitows any other person to towns <br /> t"It on,In iMinevessiseilh theeof,of steprohn a Worlc Authorized by Date <br /> Signature <br /> Qty Part No. Inv. Description & SIN Each Amount <br /> Loc# <br /> Worker Date Depart Arrive Depart Stop O/T <br /> Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br />