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Billable <br /> F e- L 3887 N.Valentine Ave.* Fresno,CA 93722 *(559)444.1730 Factory Warr. <br /> M __ ® E License No.779267*AN EMPLOYEE OWNED COMPANY I[= COD <br /> Please Visit Our Website: www.icservices.com 1= Not Billable <br /> PETROLEUM MAINTENANCE Bid J O b <br /> i- FRESNO,CA - -CO._--,-- <br /> Name: SR W 128155 ., <br /> G l � 1`l1 /r <br /> Service �A / ('¢q�� y <br /> Address: OC> cJ Date: <br /> City: /// Zip: Phone: Workoraer# <br /> ff&N <br /> Dispenser Make //I/tD Gust.P.o# AIA <br /> Dispenser Model:_ 19ncorr — _ Close coner.# 4,A� // <br /> Dispenser Serial#: kV Pumhase Order# <br /> Pump Test: Gallons: A/M Dollar Amt: &W <br /> escri do of Work Performed <br /> r N uILAC t <br /> Z1 k- <n 72 <br /> d, give authorization to LC Services <br /> Signature& Date Print Name <br /> to run my credit card as form of payment. <br /> Vas Mll nerespmumie lm ae]S.00booFkeepinelaeumvioura�umh aaslenea WaNW partylw wllaaliwrs.SM dwKbwmmenad <br /> foedmw ani of lbalamisd Waaareemenl lM Drrvstina PmlYand be mtilktlbreewn�le tllanaySlaea aM Nacauloijmeddion <br /> Card H: <br /> NallbeN�yamnxmgl mPremoC yIM1wbmebyermikymmagY ieneeiMnehllovedrmWbMenlmmnamednepoab <br /> aaaaaamymwmbinlo wao reylPm r.mPdalmePauwmlma.yaxnmr Card Type: Billing Zip: <br /> IlwrtmnNaeam bYpnme lanewssary,IMe grenlpe�mieAonlo yomoA¢e,myomaesena,bwnlatlnialusby pnwe.11lhre xe <br /> nneedlaue,mnarawama aamw isoparabla,ameaseaa reaY ba lanpondnpanana ma Dnw.wmbar. Exp Date:_/ / 3Digit Security Code: <br /> udaaamnarxiw p�mia�Mlaw,ux Poaar lrc smawal narebvaaDwadrdmaima dlwmmllas,eiuer..wamaamimDaaa,vWd`p Name on Card: <br /> mY Imdi�wmadY d mmtlienlab'tlity d Mass la a DVGmax pupoae,mtl nelHer esvmw mr eulkvese mY oNx Person b esama <br /> ImnmynabBtymwmmamaim a.a aal.daeapmaada Work Authorized by Date <br /> Signature <br /> Qty Part No. Inv. Description & SIN Each Amount <br /> Loc# <br /> IN <br /> orlcer /D*e Depart Arrive Depart Stop OJT <br /> Total Labor <br /> Total Palls <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br />