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Billable <br /> SERVICE RE ORT C=3 Factory Warr. <br /> f0 Maintenance <br /> PETROLEUM MAINTENANCE CO. I[= Not Billable <br /> FRE5NO,CA 1E= Bid J o b <br /> (559)444-1730 Fax:(559)444-1735 * 3887 N.Valentine Ave.* Fresno,CA 93722 nk License No.779267 <br /> Please visit Our Websi e: www.Icsorvices.com e~ <br /> NamevUc <br /> Service <br /> Address , t \ �� �r.��t `- nate <br /> Zip Phone work order# <br /> Dispenser Make CustOrder# <br /> Dispenser Model Close Confir.# <br /> Dispenser Serial#: Parts order# <br /> Pump Test: Gallons: Dollar Amt: <br /> Description of Work Performed + 4\ <br /> 7 <br /> .4 <br /> ty give authorization to LC Services <br /> DATE COMPLETE print Name <br /> Lh_!berea,_bbm , SAaeawlbemmmenno to run my credit card as form of payment. <br /> t­nbd eery of Te a or dla apeem L the pa 1a 9 eaN ental be enelbd'em-we sennays Ices arta:+e Loon al ntd'd <br /> MNI DemlYow oounNl rf Fruno Cdunry.tare Mrohy�nlbYodn aN ewpr«Ne nphlbewnN emdel+r�'a nn eae0llepor'la Card Type: Card#: Billing Zip: <br /> eaeeas mybue ebliN W tie'e nMow Marna oo�yaeon m tub emeineM <br /> Exp Date: /—/-Security Code: <br /> n m,ry{�,Cal�pn pY pllpfR b ngai5iy,VMe pail per'naiCn m yaJ tllrae a yar�p1s,b C911ta!*aM Ey pt-.N M9 ae � <br /> unne�abb urn a rawfip ee�ea a ooareE�e,a mueeye may be brt pewSnp a rame end phos nr.ner Name on Card <br /> Unlese omerwim revYldnV eY�"N°�°'1lC'ranus)rerebY arRasM d�arta a,wmnees wba eepeecedrr,maad,inUu6rp � + .�1� ��J <br /> any mpued wmenty d ewrC.naR'fy d em®,lv a paMylr prvnee and nwPw eiames rcr aNmxa erN oNw perser.b ese.yaa Work Authorized by 1 e l• Date <br /> hxaary!ublNy h... wAr ew"Na S"Xad r nI Narne <br /> Qty Part No. Inv. Description & SIN Each Amount <br /> Loc# <br /> Worker Date Depart Arrive De art Sto 0/T <br /> Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> Total Amount <br />