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RECEIVED <br /> RELX"LE PETROLEUM SERVICES, MVIRONMENTAL <br /> 11930 Horseshoe knad* Ph:(209)845-8586, fax(209)845-6953 License #883704EALTHOEPARIMENT <br /> SERVICE REQUEST FORM <br /> Site: 6cr,�, , <br /> W.D #: � Date: <br /> Address: -0 b Ir....� L i-"] r -I t,"e., X P,D. V 2 '7 <br /> Client: Phone: <br /> Service Requested: r <br /> .J + <br /> Description of WOrktPerformed: <br /> i <br /> 1 � <br /> ?^ <br /> i <br /> z � 3 : z �i <br /> Work Preformed by: Arrival Departure Labor Travel Total Hours <br /> Time TIME Hours Hours <br /> Guadalupe Sanchez <br /> Robert Barnhart <br /> I HAVE THE AUTHORITY TO ORDER THE WORK, WHICH HAS BEEN SATISFACTORILY PERFORMED,AS OUTLINED ABOVE IT 15 AGREED THAT THE <br /> SELLE L4R6I$IN TITLE TO ANY EQU4PMENT OR MATERIAL THAT MAY BE FURNISHED UNTIL FINAL PAYMENT IS MADE,AND IF SETTLEMENT 15 <br /> N ADE I`S AGRFEp, TryE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND TME SELLER WILL eE HELD HARMLESS yEOOR AN DAMAGES <br /> RF¢ L77 G FROM Tk RE,MOVAL THEREi7F. �f <br /> ustomer �' lure <br /> Date �— -- <br /> Print Name <br /> TRRMM'1CN 4R RAYS NGT• A F ill, CMA140E gF e9P/p FRR NQgT"W4L®5 fNARFRR OM 1RYAI6lS 4MRAtp W WO FROM#14{144#ATF IM ANY ACTION <br /> NeCF$SARY TO RMFPRFKTNIR A4RFFMR,RTr'RiA P1Yq!i MY 'pAY Re4sOryAPLE ATI'ORNFY PERF 'No <br /> 'PO#'fiRE►lRNtN!yi'#7 THE CO{Iin'. <br /> *RETURN CHECK POLICY *Return Checks will be charged a minimum Of$25.00 each <br />