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Jul 18 02 08: 36a Elite Iv Contractors Inc 209461P342 P. 1 <br /> BEC;6k <br /> VE <br /> JUL 1 S 2008 <br /> Elite IV Contractors Phone: (209) 461-6337 <br /> 2535 Wigwam Dr. SAN JOAQUIN COUNTY Fax: (209) 461-6342 <br /> Stockton, CA. 95205 ENVIRONMENTAL <br /> HEALTH DEPARTMENT P. — <br /> O.# / Work Order# <br /> D PLACE IN SERVICE NOTICE NOTICE OF SALE,LEASE,LOAN <br /> Co�nmty Date Service Agency Registration No. <br /> )C � ( 1 �� �C}9 2278 <br /> LOCATION OF DEVICE <br /> Name of Customer Address City Zip <br /> n <br /> WEIGHING OR MEASURING DEVICES PLACED IN SERVICE <br /> Cert.of Conf.No. Out of Order Device <br /> Manufacturer Model Number Serial Number Device Type (if device is new Capacity Tag Number Location <br /> and marked) <br /> R <br /> fI �, <br /> CL A\1\1 <br /> st <br /> �f 1. Is <br /> u , <br /> Tags enclosed if ap licable Oate placed in se ice Date this notice was: ❑ Mailed <br /> ❑ Yes ❑ No(if no explain in remarks) 7 //7 ll l 0 /0� 9Q Faxed <br /> Print Name of Service Agent S' a ure of Service Agent Service Agent's License No. <br /> GSSG 0GhL L) C/�; ~✓ <br />