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IEM Billable <br />SERVICE REPORT= Factory Warr - <br />S V S ID Maintenance <br />PETROLEUM MAINTENANCE CO. io Not Billable <br />FRESNO, CA <br />D Bid Job <br />(559) 444.1730 * Fax: (559) 444.1735 * 3887 N. Valentine Ave. * Fresno, CA 93722 * License No. 779267 <br />Please Visit Our Website: www.icservices.com 9 1 `5 <br />Name: # <br />Service <br />Address: Date: <br />City: Zip: Phone: Work Order I <br />Dispenser Make Cust.Order #r <br />Dispenser Model: Close Confir. <br />Dispenser Serial #: Parts Order I <br />Pump Test: Gallons: Dollar Amt: <br />Description of Work Performed <br />DATE COMPLETE ty give authorization to LC Serv4ces <br />Print Name <br />ine Aber.eponabMfa.375+bboNbewM+ptwadmyrouaoytun+na.e9rodbalhrdDelfmraibranne Shculdeonbecommenc.d to run my credit card as form of payment. <br />emp <br />ro .naa e, , e. tof rb ee..m.nt r. peyeam9 Pel thank be mbt*d b n.mn++b4.11—yi bee and C+e Coun of 111adct- <br />aha0 <br />em <br />bfyou_re, or Crenofgwlr.n <br />m.by Osa b yo. a M, ,p trap b•s,l .mabyment o, aq+raeot to Card Type: Card#: Billing Zip: <br />a <br />esm mybu abidy to 6,011 mWw anaresl oba9abm to are epe- 1 c <br />+f communcaaM by ne'.tan.c.a.ry, Ilwe pf ant D.nn�sson byo.r rdha nryor_gp w"'lXlmeusby Dhow d4ye ea Exp Date:—/ Security Code: <br />unevadab4, and a re-ord.+p deua+s operable a messapn may m .11 powenp . nm and Dh.n. —W <br />Name on Card: <br />Uoesa otbnwae Drowdnp by ww, the este (LC slfw.hJ ne.oy a Versy dsdems -w wn.lb.a...dwr eap.u.da mpled, WW g <br />mymood werntyofn"wittootyofftrwis.psbcu'rWroose andnedho,30e 4awwit'.eesnyoreDammby,{tme Work Authorized by .._ Date <br />W a arty bib" m oo.Ww wm dm W. of sa.o MJd.% <br />Dr nt Name <br />Qty Part No. Inv. Description & SIN Each Amount <br />Loc# <br />U IL Ulm <br />OCT 14 016 <br />ENVIRON <br />PARTMENT <br />Worker Date Depart— Arrivc Dc art Stop O/T <br />Total Labor <br />Total Parts <br />Mileage <br />Travel <br />Sales Tax <br />Total Amount <br />