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Co"ty Department of <br />Fod`8 and Agriculture <br />Division of Measurement Standards <br />v, <br />0 1- <br />t_jo 3 14 <br />IN SERVICE <br />REPORT <br />PUIK STOP_ MARKETS 7 <br />e� <br />1_7 <br />PLACED <br />RED TAG <br />NUMBER <br />(if applicabl <br />7erg-(9/11-i <br />Count <br />ovU l tv <br />Uate <br />Registration No. <br />1520 <br />Service Company <br />V tt(4e�v <br />Address <br />ra3 ;v �7� <br />PRECISION INDUSTRIES, <br />INC. <br />1041 S. PERSHING AVE. <br />STOCKTONp CA. 95206 <br />Name of C116tomer <br />Address <br />MAI <br />WEIGHING OR MEASURING DEVICES PLACED IN SERVICE OR REPAIRED <br />NUMBER <br />'OF DEVICES <br />BRAND NAME <br />MODEL <br />NUMBER <br />SERIAL <br />NUMBER TYPE OF DEVICE <br />CAPACITY <br />RED TAG <br />NUMBER <br />(if applicabl <br />7erg-(9/11-i <br />/ 4, '.2 - Z- <br />10e_ _r4c...) <br />P'4151 <br />GO <br />V tt(4e�v <br />fc, -Tt) <br />ra3 ;v �7� <br />el <br />Remarks <br />Red Tags enclosed if applicable Date Com d <br />Yes No (If no explain in remarks) <br />Print Name of Repairman Signature of Repairman <br />4 / o <br />to Kepor <br />rmans 1.U. NO. <br />/ - 1520 <br />