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�0-26-281 6.16AM FR SACRAMENTO EMC 9169252816 P.2 <br />Wo V 1067W <br />SERVICE REQUEST <br />Type of Business or Property <br />Facility ID# <br />Senrke Request # <br />Reftil GaswMe - C Store <br />7 <br />Fax # <br />owner / Operator who Party o <br />Facility name: Hwe fW Low #7 <br />sRe aMMM <br />dime <br />street name <br />u <br />tom. <br />type <br />Wo" <br />lftiling Address (# di fmoit !arm sft address) <br />More for Less <br />3336 Bradsibaw Road - Saitc 280 <br />Sacramento, CA 95827 <br />916-369-9740 <br />916-369-3775(fax) <br />phone #1 ' E1R. APN# Bend Use. +r <br />Phone *Z 916-369.9740 Ext 605 District Location Codes <br />RequeMoc Linda 9b fter <br />t3Llsine% Nance <br />phone # <br />Sacramento Egglpment Maintenance Company, Inc. <br />(916)925-2716 <br />Malling Address <br />Fax # <br />2533 Conalle Ortive( <br />)9�l�t316 <br />Sacramentai, CA 95818 <br />MUM ACXNQW CMENTr u ned propee�Y or business owner, or agent of same, adavowledge that al s andlor project specMc Wusuo NeALYM <br />Se Icm ENvirs NMP.wPAI rae.ALYrI eioN charges as�cratied wart thb project or activity v4111. be bftd to m6 or my as on this form. <br />I also Ce * that I have prepared ph and tT be d wql W dome Iry accordance with all aAN ,JoAOwN CouNrr Ordhame Cedes, &md&n% SrAYc and F cwAi- <br />laws. <br />Applicant Signature:, Dam: <br />Property / Business Operator /, Manager Other Atithiorized Agent Undo It Applicant is. hot the Pa proof of audeorfttion to sign ig rl4ukW ire <br />ALClNItlVlt ATiON TO RELUM INPORM4Af20Aq: When applicabie, $ the ovmer or operator of the property toc4W at the above site address, hereby sudtorbz � relem of any and <br />aN restr:s, geablxhniml data and/or enWarvirnentai/site assessment hefo»nation to the UAN ,toAquIN COUNTY auyu is MtALm ENynpeaMMIMTgy onnaroN as Soon as R h avadable and at the same <br />time It Is provided to rtic or my representative. <br />Type of Service Requested: Replacement of onnnhir sonar on Mid -Grade (89) tank. Remove water from tr inch on (87) a (89) <br />oommetses: <br />xmpeCtors Signature: Contractors s4gpe mU <br />Approved by: Empiuyee#: Date: <br />Assigned to: Emp1tJye0i Date.- <br />:DW <br />DWService Cowpkted (iF already completW): Service Code: <br />Fee Antour itt. Amount fait: Payment flaw. <br />Payment'IM <br />revoroe ar <br />Check # Received sy: <br />s. � w.. -.r -- r-4— N — % --- % rrvn-ma A —1..�i <br />