Laserfiche WebLink
[ [l : Cr; Cc1 0k1 an, HCC f"' a ooIN' <br /> or C70mmar da �-V8 'HghHiacg or 6Vlsasudrg Dorm r 2)j <br /> Registered Service Agency Location efe Device <br /> * Name } t *Company a <br /> t oName fel U►.� i eta -�`� ` <br /> i <br /> *Address � � � 7 � ' t-' *Address <br /> 12 Li\T <br /> *City , * City <br /> State , Zip cw State , Zip L 1,I lA <br /> Phone ( `�! �, ) 2 cY � - �f U L * County 7 <br /> X I X Z <br /> *Agent * Date of <br /> Name Repair or�� 51� --nC ,- <br /> Placing 7?j <br /> into <br /> License # Service <br /> Device Information <br /> *Device * NTEP CC <br /> ID * Device * Mo el *Serial Number Type of Device <br /> (i. e., pump Manufacturer Numer Number (device or (capacity if applicable) <br /> or check <br /> stand # component) <br /> S l 8 q ( Oz - D 1 9 <br /> G2 - blcl ,, , <br /> TL f�L <br /> i <br /> I <br /> i <br /> Remarks : <br /> H & S Energy, LLC I ' ` t�t <br /> 714-761 -5426 S <br /> Registration # 3776 <br /> Jesus ' (Jesse) Rouiero L ' cense # 31360 <br /> DATE . ; <br /> * REQUIRED INFORMATION Reference: California Code of Regulations, Title 4, Division 9, Chapter 4, Section 4085 (a)(2) <br /> Link to county contact information : <br /> hftp ://www. cdfa . ca . gov/exec/county/documents/countycommissionersealercontactinfo pdf <br />