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F-7 <br />SERVICE REPORT 111:3Billable <br />Factory Warr. <br />S C3 Maintenance <br />FAF&W,C�t (= Not Billable <br />(569) 4449730 * Fax: (559) 444.7735 * 3887 N. Valentine Ave.* Fresno, CA 93722 * Llaenae No. 779267 Bid Job <br />t Please Visit Our Website: www.lcservices.com N 91327 <br />Name: �`1 # <br />Address: Data: 4 <br />City: Zip: phone: Work order # <br />Dispenser Make cuss, Order# <br />Dispenser Model: cle" connr.3 <br />Dispenser Serial #: Parts Order # <br />Pump Test: Gallons; Dollar Amt: _ <br />Description of Work Performed <br />10.J kA -T <br />DATE COMPLETE i, __ give authorization to LC Services <br />Print Name <br />W-Abap*alae,.1iMDOalastnew [POW 8=1,+..wwe/.:epay kr.Wed vto run my credit card as form of payment. <br />b eee�G ue' M Pa' 0*ws at th KwRol h Pr'�a DMtl IAS b rewM bn*IdneOfa Memryh tees rri[ MOo1elM raftltlJm <br />mNlrinpareeenq}afe.noCfkytwWlPrtp7�wrar�wM�wtlrrt�tbwtry�ivpwatanneuedlnRrtb Card Type: Card #: iiillingZlp: <br />wwwmomew m I,tefIfdrIMwWieaI on!Q lieev. <br />tme+neAkeen4pMney/nnle*y, iew Peat lr.tb*byv..aMe,pygf w�gv4 bmnta<IuaMe �'jjpnr, Rlire et Exp Date: / ! Security Code: <br />eraalelb. end ■ �emrdYY dsVp h <9eleafe. a *Meelle M/ b Mtaro.Aeq• *nw end pfor mrhe. <br />Name on Card: <br />Untwamtw*4w poMdtrgbr to*, h sell 0.0 Bwri011r I�abParp7selr�'r v rrsarMe, elYar seA/rda kpMed YxleeinV <br />wirbi6d*wean/ d wownlalf{IMAM We PArU tWW'. 1W Har ass Per Moline Myope' Turin b oa— <br />t, I pr PAW <br />reastrI*seltr kiwrwraa,ame*sale C1Wd9dmya Work Authorized by Date <br />Print Name <br />Gty Fart No. Inv. Description & SIN Each Amount <br />Loc# <br />nF-V4RTENIMEN I <br />Worker Date Depart Arrive Depart Stop ON <br />Total Labor <br />Total Parts <br />Mileage <br />Travel <br />Sales Tax <br />Total Amount <br />C" <br />TH <br />