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I[= Billable <br /> SERVICE REPORT V-= Factory Warr. <br /> 5 v p Maintenance <br /> PETROLEUM MAINTENANCE Co. I[= Not Billable <br /> FRE5NO,CA IC) Bid Job <br /> (559)444.1730 * Fax: (559)444.1735 yt 3887 N.Valentine Ave.* Fresno,CA 93722 * License No.779267 <br /> Please Visit our Website: www.icservices.com 140In <br /> U ' <br /> Name: .k vis SF— --5 MN t E-CA # <br /> Service1 l 7 <br /> Address: ( I �� LATf l l�r �--�, Date: <br /> City: I— ►� I fz— �,f`� Zip _Phone- Work Order <br /> Dispenser Make_ Gust.order t <br /> Dispenser Model: __ close Confir.# <br /> Dispenser Serial #: _ _ Parts order$ <br /> Pump Test: Gallons: Dolla,Amt: <br /> Description of Work Performed <br /> N -) r - i i ( = tilCA <br /> -- <br /> DATE COMPLETE ive . orization to LC Services <br /> r^Int Name <br /> IMe ei1berioswslbbMey75001,Wks.enp IN 4n1#W si—PI 19 rePsd'•0 a tn+ornr V m4ama s'wJd 01.tea= to run my credit card as form of payment. <br /> toenfix myd Ne•pma of nu eQ•emen,me pe.ntmp pap sr+ail Da eMlbdmr•ecsve�e5:mWs kes uid ew�a..of�nsd:bor <br /> Nil ben�pu swnry)aFresno County Nro^s'ebyV�bTa+ae'rYu°gne+ihe�gh.UwMy erroroyn+nlo rur eari�.�ar�:: (,a rd"N pe: CH I'd Billing Zip: <br /> eseeas myfour ebiny b tiri�i rry/wr trrrciel obepalm m Fa epreem•ni , <br /> Exp Date: / Securi(y Code: <br /> I ton!muMWeon h pbon•is n•cessay,IMe Qenl permason to pur o7m a pu•su#s Io content muua b�pnonr a lMe ae --- <br /> eneriiebb.•'b•••mdnp e•.qe rt ep.r•w,•m•ssepo m•y b len porsM+p a n•me and prone nvnrb. <br /> Name on Card <br /> Unless oTere�>.povid•r0 by We.Ine sena;LC$ervc•q Aaeby•+pnast/d�xiame•�.wen•nees,diner espees•!a rnpfed,intlud.rB <br /> any vnpneden••Wde+ercnenteScgdAtness lospnsoDr 0..oase.end nderw esaames np eunorri••�s dhe y9'sanb Barre Work Authorized by Date <br /> Iw Re�ry eabAihhamection.,nMe.b al Bed pedugF Pont Name <br /> Qty Part No. Inv. Description & S1N Each Amount <br /> Loc# <br /> b <br /> 3 <br /> Worker Date Depart Arrive De art Sto O/T Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> _-1 <br /> Total Amount <br />