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38$7 N.Valentine Ave.� Fresno,CA 93722 *(559)444.1730 Billable <br /> Factory Warr. <br /> License No.779267-fir AN EMPLOYEE OWNED COMPANY C=1 COD <br /> Please Visit Our Website: www.Icsorvices.com 11= Not Billable <br /> PETROLEUM MAINTENANCE CO. <br /> FRESNO,CA C-1 Bid Job l- _ J <br /> Name: <br /> SR W 128155 <br /> Service <br /> Address:25D / Qq Date. <br /> City: Zip: Phone: Work Order <br /> Dispenser Make Cyst.P.o# <br /> Dispenser Model:_ 19rv—� Close Confir.# <br /> Dispenser Serial#: AM�- Purchase Order# <br /> Pump Test: Gallons: N64 Dollar Amt: _ <br /> elc' do of Work Performed <br /> 0 site <br /> v, " <br /> I r a <br /> r <br /> f` 00 fk' _i 1,44n. A- rn 72- <br /> r I, give authorization to LC Services <br /> Signature& Date VJ Print Name <br /> to run my credit card as form of payment. <br /> Vwa vAll ba respons�Lle far a 875.00 bookkeeping fee Ilmylour sounf rs ssslgned to a IhW patty ShaAd soil be Dom mmd <br /> lroerrhm say of the Semxsof Ws agreemenb lhs preArigpadyshal be mrHad toreesonable elaney's fees and the Card H: <br /> shalfbain iywacwmtyi or Fresno County Ihva hereby gradMyoum any as�gnee fhe right[o verify ernpbymenl W run euedil report b <br /> msssa mylo r Ability In[Al mylour gnmoid 9%ation to His agreement Casa Type: Billing Zip: <br /> II conwrmicagan by phone is necessary,lhva g i nl psrmtssion to you nflm,a year assigns,to=led manus by phone.It Ike are <br /> uneAellAble,mA a recording device is operable,a messsgo may be leli prmidng a name and phone number. Exp Date:-/-/ 3 Digit Security Code: <br /> Unless otherwise pweiigby In,he War(1.0 Ser-es)hereby expressly risdaims ag waoanlie%either sxpresssdor impfed,6rdredurg Name on Card: <br /> any implied warranty of merchanEabOily of Glness dor a paigcL4 prrpwa.and nater asrmea nor aulhadzes Arty other person to assun e <br /> €or it any Wilily in marieshon mlh V} We of sad products tT�7r/ <br /> ork Authorized by Date <br /> Signature <br /> Qty Part No. Inv. Description & SIN Each Amount <br /> Loc# <br /> d <br /> ort{er D e Depart Arrive Depart Stop 01T <br /> 10 2Z 1 Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br />