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Iwo, s <br /> ylmar ornia Honolulu,Hawaii <br /> • 816- -853-1165 <br /> 22985 Houston,Texas ® Kent,Washington <br /> QE TAt SUPPLIES INC.- 713-690-5111 253-W-9696 <br /> E3 San Diego,California <br /> Main Office 658-457-1!06 <br /> 13161 Telfair Avenue <br /> Sylmar CA 91342 <br /> 81$•36:2-2600 <br /> r <br /> DATE: INSTALLATION <br /> Dr: f;, ,; Act.No ';x °, ' Date Time In Time Out <br /> Street , . . _ <br /> City: . State: i t <br /> Phone: Fax: <br /> Installation Address: Total Labor Hours: <br /> City: State: Tip: Total Travel Hours: <br /> Phone: Fax: Total Hours: <br /> Date Call Received Repair Installation Warranty T hr lci n Date Completed <br /> MFG. Comp/Vac Sterlllzer ` Unit Light X-Ray Processor S!N <br /> Service Required: <br /> Parts: �• <br /> Service Performed: i a2LLL ,`$_ T tabor: <br /> T <br /> Freight: <br /> Total: <br /> Date: <br /> y <br /> . a-s " ^wr= f.. d s, 'L"a Signature <br /> y . <br /> a <br /> "REMEMBER" <br /> Shut oft your Equipment and your Main <br /> Water Supply at the end of each day <br /> White- Service Dept., Canary-Accounting, Pink- File, Gold Customer <br />