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O Y .. <br />'04 <br />Lf?CYC <br />14,r <br />JOB NAME: <br />ADDRESS: <br />CITY: <br />HOME PH: <br />T LE AS REPORTED:. <br />r <br />[]-TA M ❑ CONTRACT;;r.,l <br />DIAGNOSIS``: <br />J.H. SIMPSON CO. <br />State License No. 334724 <br />4025 Coronado Ave. <br />P.O. Box 8640 <br />.Stockton, California 95208 <br />Phone (209) 466-1477 <br />STATE: I ZIP: <br />BUS. PH. <br />iRANTY,; ;ONNLYLY, S <br />❑ C.B. ❑;rMA <br />H ; <br />RECEIVED <br />!d Ig n <br />PR ISED <br />P.O. NUMBER <br />JOB ORDER/INVOICE <br />AUTHORIZEBY: <br />SPECIAL INSTRUCTIONS: <br />CALLED IN BY: <br />MODEL <br />SERIAL NO. r„i 7..L� <br />MAKE <br />TYPE OF UNIT: , <br />' <br />SrA.A,21�, tC <br />BILL TO:� <br />ADDRESS:MAKE <br />CITY: <br />STATE: <br />PH. <br />MODEL <br />SERIAL NO. r„i 7..L� <br />MAKE <br />QTY. <br />SOURCE <br />MATERIALS PARTS & EQUIPMENT <br />UNIT <br />PRICE <br />AMOUNT <br />, <br />j'•' <br />1 <br />1 <br />VACUUM PUMP <br />I <br />(RATION DATE <br />I <br />MODEL <br />WELDING EQUIPMENT <br />I <br />SERIAL NO. <br />SER CE PER N DATE <br />i <br />1 <br />LEAK DETECTOR <br />TOTAL MATERIAL ; <br />- <br />1 <br />1 <br />MINIMUM I HOUR <br />SERVICE CHARGE <br />• �/ <br />LABOR:.�`,} <br />HRS. <br />PRESSURE CLEANER <br />THAT MAY BE FURNISHED UNTIL FINAL PAYMENT IS MADE, AND <br />OTHER SERVICES <br />IF PAYMENT IS NOT MADE AS AGREED, THEN SELLER SHALL <br />HAVE THE RIGHT TO REMOVE SAME AT SELLERS EXPENSE, AND <br />1 <br />(�- <br />FILTERS X X <br />1 <br />i <br />ANY DAMAGES RESULTING FROM SAID REMOVAL SHALL NOT <br />FILTERS X X <br />BE THE RESPONSIBILITY OF SELLER. ANY "SAME TPOUSLE" <br />REPORTS MUST BE RECEIVED IN OUR OFFICE WITHIN TEN 1101 <br />TAX <br />BELTS <br />I <br />PAY THIS AMOUNT <br />THANK YOU! <br />I <br />DAYS. <br />X _ <br />RENTAL(S) <br />GENERAL SERVICE SUPPLIES <br />=mlU <br />rI <br />TOTAL MATERIALS, PARTS &EQUIPMENT <br />� <br />UNIT <br />QTY °4ti': OTHER SERVICES PRICE <br />AMOUNT <br />CARD NO. <br />j'•' <br />VACUUM PUMP <br />I <br />(RATION DATE <br />WELDING EQUIPMENT <br />SER CE PER N DATE <br />LEAK DETECTOR <br />(HAV HEAUTH RITY TO ORDER THE WORK WHICH HAS BEEN <br />- <br />SATISF TORILY ERFORMED, AS ABOVE. I AGREE THAT THE <br />SELLER N TITLE TO ANY EQUIPMENT OR MATERIAL <br />• �/ <br />PRESSURE CLEANER <br />THAT MAY BE FURNISHED UNTIL FINAL PAYMENT IS MADE, AND <br />IF PAYMENT IS NOT MADE AS AGREED, THEN SELLER SHALL <br />HAVE THE RIGHT TO REMOVE SAME AT SELLERS EXPENSE, AND <br />(�- <br />PERMIT <br />I <br />ANY DAMAGES RESULTING FROM SAID REMOVAL SHALL NOT <br />BE THE RESPONSIBILITY OF SELLER. ANY "SAME TPOUSLE" <br />REPORTS MUST BE RECEIVED IN OUR OFFICE WITHIN TEN 1101 <br />I <br />CRANE LIFTING EQUIPMENT <br />I <br />DAYS. <br />X _ <br />RENTAL(S) <br />i <br />CUSTOMER SIGNATURE <br />OTHER(S) <br />r <br />TOTAL OTHER SERVICES <br />'.C.O D .' ❑ INSTALLED LOGO <br />