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--le <br />PUMP & EQUIPMENT <br />lot- NORTHWEST e <br />2545 North Ontario • Burbank, CA 91504 • tel 818.409.3030 • fax 818.409.3050 <br />®PW Aboveground EVR Phase I Certification Training Course <br />WHEN: Thursday June 30, 2011 <br />WHERE: Northwest Pump & Equipment <br />4433 Enterprise Street <br />Fremont, CA 94538 Ph( 510 ) 656-7867 Fax ( 510 ) 657-3006 <br />TIME: 12:30 PM Check In <br />PRE- REQUISITE: None <br />Cost: 525.00 per student <br />Class Time 1:00 PM - 4:00 PM <br />Company: f ; I I $J e-' Co 0 ST r U CM 0 u Z►ve.. Title: lw at S -"-re wt TGL u <br />Student Name: M a hy vv\ y a I d E:• :?- Phone:. 41 LL - g 1::�-- q l I) <br />Address: y 4 �!O �cc w v -e G 4. It " * Zoo F oc V-11 v C A . Q VP -3 4 <br />FAX: ct t CL - ttZ S-- o el t 1 <br />] AMEX [ISA ❑ MasterCard <br />Email <br />Card # LO -ib Sl oo '-14 aro -)q66 <br />CCV# <br />Email copy of credit card receipt to: J 7,( 12 _I ® -� , t t w e r . t.o aA <br />Exp Date omit I t I <br />Return this registration form to scastan ,nw)ump.com or Fax ( 818 ) 409 - 3050 for eBCd student. <br />Course fees must be paid with registration form. Any cancellation must be done 72 hours in advance. If we <br />do not achieve minimum enrollment, the class will be cancelled. <br />Class size is limited to no more than 25 students. <br />Portland, OR Kent, WA . San Diego, CA • Fresno, CA • W. Sacramento, CA Fremont, CA • Burbank, CA <br />Spokane, WA Phoenix, AZ . Anaheim, CA • Anchorage, AK • Honolulu, HI • Las Vegas, NV 6 Pasco, WA <br />