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f+ � MEDICAL INSTRUMENTATION SERVICE PERFORMED <br /> CALIBRATION&THERMOGRAPHS <br /> INC R P O R c <br /> k � 1731 Howe Avenue ► c o <br /> Suite 248 <br /> Sacramento, CA 95825 <br /> (916) "7-2287 <br /> DATE °`I,,•C SERVICE ® c <br /> REPOS NO. 0423 <br /> CUSTOMER NAME �- t'tj <br /> ADDRESS <br /> CITY PH. -32- - !Z EXT R. O.T. R O.T.INITL. LA HRS. HRS. MILES INITL. DATE HRS. HRS. TRVL. MILES <br /> EQUIPMENT LOCATION C'�tJ1 C BME NO. MFG. <br /> (A) �;,'(�C�Jfi MOD. P/N S/N <br /> e <br /> (B) MOD. P/N S/N <br /> ACCESSORIESJ TOTAL TOTAL <br /> PARTY PLACING CALL `�! POSITION ® , QTY. PART NUMBER DESCRIPTION UNIT AMOUNT <br /> PRICE <br /> AM ❑ eo <br /> DATE CALL RECEIVED TIME PM,'Qb //� <br /> REASON FOR SERVICE/COMPLAINT G 0 40u,i /lZ,/,b 1J <br /> ` Gt3 ® C 2,2,20 <br /> G <br /> G ® <br /> 7, 30 <br /> If p G <br /> OBSERVED -2- "~ <br /> ® <br /> CL ROKER CONTROL <br /> F PFRES. MFR. ® CONTROL CONT <br /> TELEM. SET SE' <br /> ESU ® CU' COAG Bf 'WR WR ® MIN "AX TYP�,E/OF SERVICE: CUSTOMER P.O.NO. MATERIALS <br /> (A) D CRO D M LOX" MFR w/S w/S !u WARRANTY <br /> I LEAKAGE® ®® ® 30 rAq:5 cF 0 CHARGE . <br /> (8) UN <br /> D GRODED l�L MFR. w/S w/s Dat® MFG. ❑ LABOR <br /> LEAKAGE, I ® ❑ NON WARRANTY <br /> rc ST CCEPT E E Ai AURH.BY nZ <br /> �2EPAIR CUSt ❑ MILEAGE q/ <br /> 7 (BRACT LABOR �D ❑ <br /> ❑ CONTRACT <br /> DATE FINISHED DATE EBHiNED PREPARED C ETED BY TAX <br /> ®30 <br /> m _ INSPECTION O.T. ❑ ❑ <br /> ❑ THERMOGRAPHS SHIPPING <br /> AND <br /> MooEL SERIAL NO. - ACCESSSR r r,-_ u ❑ INSTALLATION <br /> TRAVEL ❑ INSURANCE <br /> • ❑ OTHER <br /> PARTS/ ❑ <br /> I If SERVICE PERFORMED AT: MATERIALS Q� <br /> SHIP DATE CARRIER <br /> yy BIO ENGINEERING ❑ CLINIC V__ ----. <br /> !SHIP!VLAGH 0 AIR 0 UPS 0 H/C 0 HOSP. 0 OFFICE <br /> SHIPPING�' <br />