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ii:t� I a Work Order# 375524 <br /> FVelervice Site: S53 Tracy Fedex Ground <br /> r•7 5855 Hood Way <br /> Pbone• 1-800-215-4839 x2 FSR#: 9012 Franzen-Hill Corporation- Tracy, CA 85377 <br /> + Tulare A <br /> Fax: 1-305µ6294288 FSR FAX#: 775-329-3301 Phone: 20k39-2080 <br /> Werk Order Summary <br /> This form must be COMPLETED &ATTACHED to all invoices submitted for payment. <br /> Trip# Date Arrival Time Departure Time Travel Hours Miles Traveled <br /> +^ ' - 1 3,0,0" ! , r, per^ �3` ` . -- /�7 ' /lir <br /> Description Df Work Performed*:� ;(Required) <br /> 'e I/'"[�.!is,t LSC_ <br /> i <br /> verify that any dispensers put in the override mode during service have been returned to the normal operating mode. <br /> lie <br /> Tech, Name(Printed) Tech Signature 'Date <br /> <__ -----.--(Require – <br /> if additional trip Is required call 1-281-647-8900 x2 and request additional "work order summary" <br /> Material Used (Attach list if required) <br /> Part# Serial# [Description Area/Locatlon Date installed <br /> 1I1..i 15 L <br /> Ull <br /> `�NVIRONVIE.-,�TAL HEALTH <br /> Customer Comments OEPARTME'NT <br /> I verify that all work was performed as described above. <br /> T ` <br /> Customer Name(Printed) customer$ignetura Date <br /> <.- _(Requlred)-- -a —- <br /> Page 3 of 3 <br />