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ARWi/AS iNC . <br /> EXCELLENCE • INTEGRITY * QUALITY <br /> United Pacific UP5446 10/26/2023 <br /> • � o - 1403 Country Club Blvd. • 10395 <br /> Stockton CA 95204 USA - •• •• 23781360 <br /> • 5446 <br /> Broken Bravo chain 7/8 lob Complete? ✓ Yes <br /> If Not Complete Email Support <br /> Performed:Service/Repairs <br /> Arrived on site to find dispenser#7/8 91 octane bravo chain broken. Removed old chain and placed new <br /> one in. Tested new chain and tested great. <br /> t <br /> Materials/Rentals Used- <br /> • Qty <br /> Chain and Clip 1 <br /> ❑X Steel Toe Boots © Safety Vest ® Safety Cones/Tape ® Gloves <br /> ❑ Hard Hat ❑ Hearing Protection ❑ Protective Clothes ❑Fall Protection <br /> ❑ Hot Work Permit ❑ Lock Out/TagOut ❑ Safety Glasses JHA# <br /> nio Coffman <br /> Terms:Site issues may not q4vs be resoly in one trip.Due to intermittent , • • <br /> problems or defective equipment while the technician is on site and cannot , <br /> duplicate issue.It is the Sites/Customers responsibility to make sure the <br /> information on the work order is correct before signing this form. <br /> A finance charge of 1112%per month,which is an annual percentage rate of 18%,is <br /> charged on all past due accounts.Freight prepaid by seller does not include any"car o coverage" <br /> which is the responsibility of the buyer to purchase if needed.in the event of effo or legal • <br /> proceedings to enforce the collection of such sums due herein,customer agrees to reasonable <br /> attorne s ees. ` • <br />