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%A11111=®BeY 0%Otter @W®®111 i® fa <br /> ,i, u `Y C= Maintenance <br /> Not Billable <br /> Bid Job <br /> -eatl * Fax:(559)444-1735 * 3887 N.Valentine Ave.* Fresno,CA 93722 * License No,779267 <br /> Please Visit Our Website: www.icservlcer,.com <br /> Name:- �a i Se-,y s 3P �� x97150 j <br /> Service : L ate: 1-7 <br /> Address_ pf j <br /> city: cin + c cL Zip: Phone: Work Order# I Z ��� <br /> e— <br /> Dispense,Make Cust.Order#�� <br /> i <br /> Dispense,Model: Close Connr.9 <br /> i <br /> Dispense-Serial#: Parte order# <br /> Pump Test: Gallons: Dollar Amt: <br /> Description of Work Performed <br /> `7 G n r fit?- <br /> t '� n t <br /> o <br /> DATE COMPLETE s'2- -1"7 [, give authorization to LC Services <br /> Print Name <br /> IMemOta n,go,,,awar eS7iWEodseephpke8aryrar acweR6eupxdbawdPetr brahcims.6laordf v2ia We,rKaad to run my credit card as form of payment. <br /> n anbn a"f d F.e wn�e d di eOwT++I pu PAHO Idb+h++U ae.nGhd b reawr+r6r eema�e Me W Cw CUre,01 M+fdxbe <br /> LhinbehUmmurM xFrumCP+M/�/eMaeY7�IbyoVbtTJeY,pre.eEir�,IblTriryem�,oeNarv.,evl6trtpRlb Card Type: Card 4: Billing Zip: <br /> eeuu r,ryMr eealy b R[n rr�v.r(nanu�palgedpl q b6 a�anneM <br /> Ilcanvmnk.ImMphmwlsamessax b,e DeYIM�*A1>iP'.b}WR ofca,tl}ar avigra,bcoNxlewW 0Yy1pM htk.en Exp Date: / / Security Code: <br /> ,nmtleh'a,u,daraeorCnq 6ft"6awibla'a aleeaege maybe Rh P'Adgane.Tw M pwx-t.. <br /> Name on Card: <br /> tlddaoMrdN pmlQiybY�,M eslr(lC wr ey heray eeprsaH dxlim N r erne,aTa tyntredat Fepwd,bdu6np <br /> arty tmyhdeneNY alawchn66EttdNxmbepaEcJrp+Ww,ndn.77r wxsna aalu6a,an7oew pemnbas�ena Work Authorize Date <br /> tar i art1 epa&y4,tarneefoa e+ai Pe uM d ardPraMda Nam e <br /> Qty Palt No. Inv. Description&SIN Each Amount <br /> Loc# <br /> Worker Date Depart Arrivc Depart Stop O/T <br /> Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> Total Amount <br />