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IE= Billable <br /> SERVICE REPORT = Factory Warr. <br /> S V 5 IE= Maintenance <br /> PETROLEUM MAINTENANCE CO.FRESNO,CA Not Billable <br /> (559)444-1730 * Fax:(559)4441735 * 3887 N.Valentine Ave.* Fresno,CA 93722 * License No.779267 1 IE= Bid Job <br /> Please Visit Our Website: www.icservices.com <br /> Name: �(�y�Sr�S M��/ t'�C�k i3PZ # 100695 <br /> Service (Al ,� ' ( J _ G G <br /> Address: (� � 1.. t,l \I ( 1 �(/(� Date: <br /> City: _ Zip: Phone: Work Order# <br /> Dispenser Make Cust.Order# <br /> Dispenser Model: Close Confr.# <br /> Dispenser Serial#: Parts order# <br /> Pump Test: Gallons: DollarAmt: <br /> Description of Work Performed <br /> - i t c� <br /> SO -L&(-5FALL—F(D Rs?IAIr <br /> l i a'i .5 i P <br /> DATE COMPLETE I, give authorization to LC Sery <br /> Print Name <br /> pea erl be nspondble lor a$75.00 bookk.WIrg fee d mylour ar 1 is assigned to a Olid perry for cdkcions,Snoold sultba commenced to run my credit eard as form of payment. <br /> lo enforce any of Na Wrens of his ageemenL he Milling party shall be enliNd to reascnat!e eWmWs fees and he Cast of juirF.Ubn <br /> shat be In(your count')or Fret.Ceunty.4ae haebyfir ni to you or arty antgnee the rlp!i to verity emp'ormml or nm■a Crireport to Card Type: Card#• Billing Zip: <br /> aeras myfou.bliy k kMil myfour fmancttl obhg.b n m Ods epoemenl <br /> Il commwicnoo by phone ie nensmey,uae Rant permission 10 Y oFf� aYom ass!gts,b contact m ius I+1'phone.A lMen Exp Date:_/ / Security Code: <br /> unneiWe,end a rmr tg devixe is oMeele,a message may be feO pcN6ng a name and phone numM <br /> Name on Card: <br /> Unless od'"m prosiJnp by In.Uu salr(LC S—W)heeby eapnssy dsclams b esrtom s,Bihar expessedor m*d,hdLdmg <br /> arty rono,d rrnany of mrdnlabYiy of fianaa for a Par War prtpose,ndneihr-e,nor aulharims eny other paaon b essume Work Authorized b Date <br /> for II any OabMty In co meeten eth fie ea'..(..id poduets ✓ <br /> Print Name <br /> Qty Part No. Inv. Description &SIN Each Amount <br /> Loc# <br /> i2C.Z � i�01Z <br /> 9 <br /> Worker Date Depart Arrive Depart- Stop _ 0/T <br /> 501 _ V _ 76 + Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> Total Amount <br />