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10/17/2002 15:10 310570 4 j PETCON TECH IN'- PAGE 03 <br /> 10/16/2002 15:48 2094683433 FIFTH FLOOR PAGE' 02 <br /> SERVICE ACQUEST <br /> Type of Euslness or Property FA FTY 10 9 SER149CE REQUEST O <br /> OWNER I O'PEFATo SILuttG Paan <br /> WeS� cv s+ <br /> FAclLrN NSE rco S--TT S <br /> SnADC"sa <br /> V�9rm+�br bGveka Twp sun,a <br /> mailing Add ss tlf Di`ferent horn Site Addrs sst <br /> $TATE Zip <br /> CrFY I <br /> PHt)NE#1 tom. l APNit WDUSEAPKJCATION' <br /> t ) 10c, <br /> PHokE BGS OIStR)CT , . LDCAISON.000E <br /> CONTRACTOR r SERVICE REQUESTOR <br /> Bti11ur�P <br /> RFaucsrna A <br /> BUSINESS NAME f PHONE# [zr. <br /> G(nhol peS ( hC . to <br /> ;mZumal AIDOREss E t.flOLC /�V� ��` b �1q�114 <br /> W ��0 r►'�-- STATE 71P <br /> BILLING GKNOWLEDGEMWT:L the unoe*ned PmPert`!X bustness owpitr,apargtor or authartzed arjunt of same,ackt0wi*15 Out as etre andlor Project s;tC3: <br /> ptsuc HFi11.Tt+OMS1CN ncurty ms's a ciaied C><s p�jert ar eGiv;�vn11 be btYetl a mn cr my bus er as idrxs5W M ft form. <br /> I also cumty'nat I have prepared S,e zxkztioa and than c1e woc+t m De polomred wM be done iv accorda(XM wills ap SAN JCAWIN COUrrtr O&Ar,&1ce Cudat S)ardards.Sr rTrw and <br /> F[OMAL 14w9. ✓�_ <br /> APPLr-W 51Gw, OATS: � f - <br /> RaOPERNl9US�+fssOWNEA 3 OPERATOR/Mart+GF� ❑ QP4ERAUlru=AG:iir Cl <br /> dArPrx�vr�xrUeBc� cPum yr*6fCd-*w Tato <br /> AUTt CRQAMNTQ RELL°A3E INPappsmble,t,Ore ewnar or uva=r of the Prvpe+:ty lewd at Ale above zlie address hereby m4mcftm me release of <br /> any end 8tr resulra,,9rnie$1 data avatar er7vtionrrsenaV51e assess.naat tnfermadan to dse 9AN Joncttel CLtJI�r'r Pv8t.ic I�TH SErysCEs F�+acw�,NTu.I rEsL;~+OMstoN as soon <br /> as it is availaue and at ma same time a is provided k�ns°Or my represerutm. <br /> TYP£cr SmiCG R£WFSfED: <br /> Q�6 ti�EN4�P <br /> iNSPECTOR'SSIGNATUR . 00tt7RA cie rG TURE• <br /> APPRrn aY: '� _ ��. C i^ C j <br /> DAM (� 7 7 (� 2_ <br /> AmGNE)To: EMPLOYEE iL GATs: <br /> Data Service:Complet-Ld (if already camp(eer d): Semp Capp; . -P/E. <br /> Fee Amount: 1 (1 ) Amount Paid Payment uk <br /> Paymont Type Invoice Y Chock# Received SY <br />