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2533 Connie Drive Federal ID#6"110167 <br /> Sacramento,CA 95815-2809 <br /> Customer <br /> Job Location wa#?1221>S� Work Order# <br /> Emn's Teraso 11 ChevrOn Vall5m Date Received: Jason {d s to <br /> Emil's TaZWO Chaeko Thomas <br /> Chwko Thomas 1405 Caffernla Ave Contact: <br /> 1405 C1190ft la Ave E sealon,Ca 95320 Customer PO# atudstex <br /> Bsealoa,Ca 95520' 209_R38-7674 <br /> 209-087674 ase Site-2 Mm or 1 Man Station# <br /> Work to he Performed: I do not nW w rolHaa 01HM on Pos indbrexxerproblow <br /> Awtr,�sre:J.a►errn *paty ann-t5eamrm=POS&dktezxer■" evaivs.Rnnxever presetl20.Can doce0when inarea <br /> Jason wants eslra console dials�p0 015PC,also#4 d(ind need 2 stag <br /> / <br /> 1Z Mfg M'Ad sabl <br /> Work Perforated: j o, tt <br /> K 1 �� <br /> O <br /> l jet e� <br /> Pending Problems: <br /> Parts Used <br /> pry PaIN Mrg Doc Neo Serial# COR Pm# Cort Seevlq EQID Pouf Come Aci <br /> lon <br /> 1 <br /> 6j <br /> loC, 6&1 �i s a c EM C S < <br /> DaR Tech On SiteTime StoreSamp&Signature <br /> Initials <br /> Arrival Departure <br /> - t <br /> Office Use Only: <br /> f <br /> . Signature: /I Print Name: <br /> Subject W con " on back hereof. <br /> Data Entered? Yes❑ Notice:A inance Charge of 1 1/2%per month,which is an annual percentage rate of 18%,will be <br /> MOB Yes❑ charged on past due accounts over 30 days Conhactm aze reclmrea by law to be licensed and regulated <br /> W+M Recon Needed? Yes❑ No ❑ by tgghe Contractor's State Licease Board. Any questions conceming a contractor not �e referred O Bode <br /> Monitor Repon Needed Yes❑ No 0 No 0 lt5fi"aoff theeBoard 958 address <br /> dress Is: Contractors State License Board-9835 Geo <br /> Job Complete Yes <br /> White(Eine)// Blue(Eine Pending) // Green(customer copy) <br />