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REGE ` E <br /> '!" 24/0/ a <br /> Work Order# .3s3}9�66— <br /> OCT 22 2018 K-T6j ew % <br /> F7,lf'l S�'f"UtGeS site: <br /> 1`�I MENTAL�HrrEALTH a Seor*,A��in <br /> Phone: 1-800-215-4839 x2 w"" �� �Np[� puration- CA 93239 <br /> Tulare Y <br /> Fax: 1-305-629-4288 FSR FAX#: 775-329-3301 Phone: 559-386-9748 <br /> Work Order Summary <br /> This form must be COMPLETED &ATTACHED to all invoices submitted for payment. <br /> Trip# Date Arrival Time Departure Time Travel Hours Miles Traveled <br /> 1 ro-<9�g11 OQ CoQ <br /> �IQ;10I,A <br /> Description of Work Performed :(Required) <br /> t-041P�.��, �ti v r iv e c <br /> C <br /> � S <br /> /lrs�� UeN �Q X <br /> gSQ-tis Q,-s mss, d <br /> I verify that any dispensers put in the override mode during service have been returned to the normal operating mode. <br /> Tech. Name(Printed) Tech Signature Date <br /> — <br /> If additional trip is required call 1-281-647-8900 x2 and request additional"work order summary" <br /> Material Used (Attach list if required) <br /> Part# Serial# Description Area/Location Date Installed <br /> Customer Comments <br /> 4 <br /> t <br /> I verify that all work was performed as described above. <br /> / U <br /> �Au0 VM <br /> 4 Y \ <br /> Customer Name(Printed) Customer Sig re Date <br /> c < --------- (Re ui ------ <br /> f <br /> Page 3 of 3 <br />