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Elite IV Contractors <br />2535 Wigwam Dr. <br />Stockton, CA. 95205 <br />VPLACE IN SERVICE NOTICE <br />Phone: (209) 461-6337 <br />Fax: (209) 461-6342 <br />P.O.# / Work Order#__.____- <br />5�;;� 11 X019 <br />NOTICE OF SALE, LEASE, LOAN <br />Service Agency Registration No. <br />County <br />Date <br />1 I ii % <br />512. O <br />1. <br />LOCATION OF DEVICE <br />zip <br />Name of Customer <br />Address City <br />�"' J <br />// m1 <br />IN SERVI <br />WEIGHING OR MEASURING DEVCICES PLert. O <br />Device <br />Model Number <br />of Conf. TACED <br />o. <br />e (if device is new <br />Serial Number Device Typ and marked) <br />of order <br />Capacity Tag Number <br />Location <br />Manufacturer <br />t/ b V <br />C2 ss 22, o, 213 its - _ <br />60Az� <br />it )e l <br />11gE�n <br />V S7— <br />L/5r'N <br />�s fl 3 <br />C. "Mott Z S <br />LJ - -31-, iZ Ai— <br />ftL'o� <br />� f L) <br />_ <br />r3 <br />V J1- <br />V <br />p r 1 y, ✓z <br />t-) 1 fq— <br />,\/ I <br />V D <br />C agg2u A,,SE <br />Remarks: <br />❑ Yes ❑ No (if no explain m remarks) <br />S <br />Print Name of Service Agent <br />J in service <br />/jq <br />of service <br />Date this notice was: ❑ Mailed <br />❑ Faxed <br />Service Agent's License No. <br />