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SERVICE/REPAIR )OHORIZATION <br /> u OOC35POOLERMCL <br /> O O^O'OOfr`I BMUF %]E,H7 coolElia <br /> CALIFORNIA CONTRACTOR LICENSE 3091 5 A-081/010 RAZ <br /> 808 N.UNION ST.%TOCKTON,CALIF.M205 <br /> P.O.BOX:OB STOCKTON,CALIF 95201 <br /> PHONE 209/Q 8333 <br /> SALES SERVICE INSTALLATION OF PETROLEUM DISPENSING LUBRICATION B INDUSTRIAL SERVICE EQUIPMENT <br /> DATE <br /> P.O.# <br /> AUTHORIZING NAME COMPANY NAME <br /> BUSINESS ADDRESS ST. <br /> LOCATION <br /> CITY ZIP PHONE <br /> AUTHORIZED REPAIR OF THE FOLLOWING EOUIPMENT <br /> I HEREBY AUTHORIZE THE REPAIRISERVICE WORK TO BE DONE BY STOCKTON SERVICE STATION EQUIPMENTCOMPANY <br /> INC.AS DESCRIBED ABOVE ON THE EQUIPMENT NAMED HEREON.ALL REPAIR PARTS ARE TO BE BILLED AT S.S.S.E, <br /> REGULAR PRICES,I AGREE TO PAY CASH FOR SUCH REPAIR PARTS AND LABOR ON DELIVERY OF EQUIPMENT OR ON <br /> TERMS SATISFACTORY TO S.S.S.E.AND UNTIL PAID IN FULL ANY UNPAID BALANCES SHALL CONSTITUTE A LIEN ON THIS <br /> EQUIPMENT:I FURTHER AGREE THAT S.SS.E.WILL NOT BE HELD RESPONSIBLE FOR LOSS OR DAMAGE TO SAID <br /> EQUIPMENT FROM FIRE,THEFT OR OTHER CAUSES BEYOND S.S.S.E'S CONTROL <br /> I AGREE TO BE INVOICED AND WILL BE SUBJECT TO TERMS. <br /> AUTHORIZED SIGNATURE TITLE <br /> x <br /> FORM R 0015 <br /> CUSTOMER COPY <br />