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Jul 18 02 08: 37a Elite Iv Contractors Inc 209461A342 p. 2 <br /> Elite IV Contractors Phone: (209) 461-6337 <br /> 2535 Wigwam Dr. Fax: (209) 461-6342 <br /> Stockton, CA. 95205 P.O.# / Work Order# <br /> PLACE IN SERVICE NOTICE NOTICE OF SALE,LEASE,LOAN <br /> ounty Date Service Agency Registration No. <br /> 111."1 is Cite ,����, %i i`1 i 2278 <br /> LOCATION OF DEVICE <br /> NaTe;f Customer Address City Zip <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 and[narked) Tag Number Location <br /> ,^ <br /> L-114 <br /> fOkU ` MGT(% % X3 .4 <br /> c) 1-14,1,i7 vaf�L'"d <br /> t� n <br /> L"N <br /> MIAi i t <br /> l <br /> Tags enclosed if applicable Date placed in service <br /> c3 Date this notice was: ❑ Mailed <br /> C3 Yes ❑ No(if no explain in remarks) 7 117 / O� <br /> '7//q 10 �ff'Faxed <br /> Print Name of Service Agent Sifrnalure of Service Agent Service Agent's License No. <br />