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2016-11-10 14:37 Visalia Sales 15597320817 ss 2094683433 P 2/2 <br /> RECEIVEPrIo.QUINCOVYF1 ENVIRQX.IF..FALNE..LrnDF:F'ARI.IF:X <br /> SERVICE; UQI'EST <br /> Type of Business yr Property �• FACILITY ID 0 �!' SERVICE REQUEST 2 <br /> ENVIRONnFNTAL HEALTH <br /> Valley Pacific Petroleum CHECK if BILLIKr.Ao044.-SO <br /> r::ART NAME victor Road Cardlock� <br /> SIT�E�AADDREss <br /> 7111.1 <br /> __.�• �Yt�T�' �� r-�,-•L�; �Z vo. .. <br /> JU TI <br /> NOME Or MAILING ADDRESS fit Different from Silo Address) 4152 Frank West Circle <br /> r'�-.••_••-• ..•._ .._..-...0 r...._.- �drM IL�mNMr5lrerl Nin.. <br /> I CIT` Stockton STATE CA Zip 95206 <br /> PNpNE91 r• . APN d ! LAND UaE A✓PLIGANON A <br /> 1209 ! 993-8793 <br /> ! 2091 ....._...........,,, ..._.. --- . .p^W` . <br /> •PnOKEv2 TT ) p BOS D <br /> is*wc� LOCATION no� NCOOr <br /> 948-8412 322 Ytl - <br /> _CONTRACTOR / SERVICEREQCIti"IU_R ' _ <br /> REOUESTOR Mike Eliaeoa <br /> GNCCK II$41M4 M.nMF<.413 <br /> ausiwEssNAME -._._. .__...__. PNONE;a r•• <br /> Valles Pacific Petroleum 1209 ! 993-8793 <br /> HOME,Or MAILING ADDRESS : F:x d <br /> 7.52 Prank West Circle t 559 > 732-O917 <br /> COT Stockton STATL CA Zw gg206 <br /> BILLINC t('6.NOWLF"DGENSE%1' 1. Ih.• rmrrly•ne,l proprefor hneineNN owner. operator or authorized :hent PI , miv <br /> aJl,n.•a ialee T?+ar all Nue and or pnna•tt .peal: 11t arr11T11 \I t: it U I it UI pIN I:I.•.I hourly .aa:pe, aN,�•:Ia:cJ nt:i: <br /> %%Ili h:1•111eJ III use rn m) lu,ine.,.1..IJennf i.•ri on thl,tam <br /> 1 ,1bu r end, 'ha! I 11!el the null.lu Ix•i>erfi.11wa will he.i✓nr u:,:.:utd.rl.c w1:::,L:S%'. I <br /> l •.11 /Iry)tnpr+.t'(nrl1.,.\hlrniLi1..\1111 anJ I'1111 N 11 IJu,, <br /> APPt•I ANVSSIGR4TURF,: _ <br /> I`Nnrikll t)I,PI�,QN N1.R❑ r1rl k,lUN. It 1,u.l ll ® 011114 %1 1114111311 IT %4.1%11,tr,,1 <br /> !l grr•ul nJn nr.r:h, 11u J:•..!'N": prKr+J++/nrrrlerpi;.priao rn,i);n i..rryuirrd rrr• <br /> �7HUR1%Al'IQfV 1'(1 RF;I,F:ASt'. i\FUR\1.1'1'10\: 11 hal::ppliarhle. 1. I!1:owner/r: epee ahlr.4; "!,;Irroprrt� a.Na::.;,r ' . <br /> ,ftv addrvk%. he1cF`} aulhmvc the r;k^v .uq .111.1 all .e+uh., y:n:ccha4al doa .md re <br /> "r4 a'rn.::0•s:o!Iw j r, it vl 1,,1 ,r: 1,1 It %I .1!1);v V!ill)V :f.414m :1,11 11%11111IMr A." 11•c•ar11J r.•.; . <br /> p:�•.mnf'.•etc,.r m) (cin e.ehfae4 e <br /> TYPE OFSEfinCEREOUEOTED: -._. • _.—_______ __-. "._.. - ._.__—_. _ <br /> CoyMs�r. <br /> ACCCPTED aY: EMPLOYcc X: DnTC. A\ <br /> 0.;g1ONED TO: EMPLOYEE of: DAT E: <br /> Date Service Completed Of already comPlotod): SEAMCI CODE P E. <br /> Fro Amount: Amount Paltl 1 Payment Date <br /> Payment Type ,Invoice C i Check# Received By: <br /> a:!Stb ' 4 <br />