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(= Billable <br /> SERVICE REPORT (= Factory Warr. <br /> 5 V S Iaintenance <br /> PE7RwCJ M <br /> AIN�^�CO � Not Billable <br /> (559)444-1730 * Fax:(559)444.1735 * 3887 N.Valentine Ave.* Fresno,CA 93722 * License No.779267 I[= Bid Job <br /> P ease Visit Our Website: www.Icservices.com <br /> Name: # <br /> Service N2 94804 <br /> Address: � f` <br /> /7 Date: / y� <br /> City: C/I�. Zip: Ph7 <br /> Phone: Work Order / <br /> Dispenser Make Cust.Order# <br /> Dispenser Model: Closeconrir.# <br /> Dispenser Serial#: Parts order# <br /> Pump Test: Gallons: DollarAmt: <br /> Descriptio of Work Performed <br /> 4 � <br /> DATE COMPLETE7--1 4 1, give authorization to LC Services <br /> Print Name <br /> Inv.a bo raspmdirtr eSri.00 aaorar,Daq FriAraNarrw>.nIis ass edM eLttd Day In cdvckns.ShWd.9beoorreaKad to run my credit card as form of payment. <br /> b mYaco arM d M terns d tis tDaann4 or r+��W DaY vAot!6e erPbd d reemnabw�mr/e hes eid no met ciprivSaon <br /> rlel bfnlyna carry�arresnocrrly 3WaharGy qad ID a mryescFn i*11,A1U seely onO�Artnl a —dr r'wto Card Type: Card fE: Billing Zip: <br /> uvu we+r*Ati!o Vill rerror hwcial abl kr bT's rJen w1. <br /> ItamvsnkefsnWDhoro�sreoossry,Vee ge7l pemJssinhyan ofRn,asvaevlg a,bsxaterNaLyph'v+e dWeae Exp Date; / / Sefflfiri Code: <br /> �ne,•edallo,aid a rocadog drdoo Is operable,a a.ouago raay 4 left rrmid�g n nae4 and rAwrw wmnm, <br /> Name on Card: <br /> I;n.ass o7.mnise R�^Py'I Inr,U'e color SLC bervivs)Lroraby espressy dLdamo er waronEes,eiM erysesseda inptRd,ntludrr, <br /> ary np6ed norrany or mcrcAanla6iiyd Nmsa laeperSaAe prporo,wed naiaa ewmea ncr erMnine enYo'hx Dason beesvrae Work Authorized b Date <br /> fa h ea/BaOLy h[arecSoRMT Ns sale d sdd RuduCs. y <br /> Print Name <br /> Qty Part No. Inv. Description &S/N Each Amount <br /> Loc# <br /> 2 , <br /> Worker Date Depart Arrive Depart Stop O/T <br /> Total Gabor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Sales Tax <br /> Total Amount <br />