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04/14/2008 13:58 FAX 20982390?' 017/020
<br /> DM�TLL SEPTIC
<br /> N, I"2-Q&ft,[p•(209)8'L8•s110 (r09f 82,3-611x1
<br /> ROM'u-61 J.121 NEW ACCOUNT A'# �I .^� '.1: �r, ....•.�>a.•.,..-
<br /> WS784e tt+ 7
<br /> LOCATION DAT{E' p
<br /> UUAI_T1°Y SL-'RUSCES .' 4�j'Ip9..:., ,r. ,: t'. n
<br /> 1 COUNTRY MANOR r r.i.:,, s ::. r _iri�',.L„c.
<br /> 17251 N. TRET'HEWAY ROAIJ C9RFreN BA's,
<br /> LOCKEEORp
<br /> SILL 70loom
<br /> QUALITY SERVICES ?r'...,.. . :::,.I .,•,Mq,:•:, : [ •'„• baf s3a
<br /> 27348 E. HWY 120 OTY y DESCRIPTION AMOUNT
<br /> ESCALON CA 55320 PRICE
<br /> SERVICE REQUEST
<br /> PUMP SEPTIC, 1 LOAD
<br /> INSTRUCTIONS ;�I
<br /> •�.r", JUS rii.ly.
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<br /> TBCI IANTINE 9TAATEP + Q AM
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<br /> 3/ / �— M T Me COMPLETED-u ° El AM
<br /> c�.JC^JTOTAL MATERIALS
<br /> ❑ PM
<br /> REGULATORY COMPLIANCE CHARGE
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<br /> SaWlCE'IS MOMiDED ATTHE OPTION OP THE LE99EE. LABOR
<br /> PAYMENT DUE UPON RECEIPT TAX
<br /> PAY THIS AMOUNT 04.
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