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1-1 Billable <br /> SERVICE REPORT Factory Warr. <br /> Maintenance <br /> cN EUMM—AZN—TMMAA10E=Co. — - IE= Not Billable <br /> FRESW CA <br /> [= Bid Job <br /> (559)444-1730 * Faxq59)444-1735 * 3887 N.Valentine Ave.* Fresno,CA 93722 * License No.779267 <br /> I 'pl Visil Our Web its: www.lcs9rTes.c <br /> Name: # N2 104105 <br /> Service <br /> Address: ? Date: <br /> City: (� Zip: L) Phone: WorkOrder# <br /> Dispenser Make Cust.Order 0 <br /> Dispenser Model: CloseConfir.# <br /> Dispenser Serial#: Paris Order# <br /> Pump Test Gallons: Dollar Amt: <br /> Description of or Performed <br /> It L <br /> DATE C PLET I, give authorization to LC Services <br /> Print Name <br /> gm"rAbsto run my credit card as form of payment. <br /> Card Type: Card# Billing Zip:_ <br /> Mae M&W abft Ig ks wow Sam"ob%dm b ft*Wawa& <br /> Exp Date: Security Code: <br /> Name on Card: <br /> Work Authorized by Date <br /> to R . Print Name <br /> Qty Part No. Inv. Description &SIN Each Amount <br /> Loc# <br /> Worker Date Depart Arrive Depart Stop O/T <br /> R <br /> TKA5 I -Total—Labor'AIS Total Parts <br /> an LE–ZI1-5 <br /> Mileage <br /> Travel <br /> Sales Tax I <br /> Total Amount <br />