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Placed in Service Report <br />for Commercial Weighing or Measuring Devices <br />Registered Service Agency <br />Location of Device <br />*Name <br />LC SERVICES #2558 <br />*Company�� <br />Name <br />2d 7^ra��( rl <br />*Address <br />3887 N Valentine Ave <br />*Address <br />t-1 8S 0 S YW y 97 <br />*City, <br />State, Zip <br />FRESNO, CA 93722 <br />*City <br />State, Zip <br />S b 0 �� ^ r�1 9 �,�( f <br />Phone <br />( 559 ) 444-1730 <br />*County <br />San ) 0 UI'✓t <br />*Agent <br />Name <br />JAIRO BAEZ <br />*Date of <br />Repair or <br />Placing <br />into <br />Service <br />I <br />License # <br />32553 <br />Device Information <br />*Device <br />ID <br />pump <br />orcheck <br />stand #) <br />*Device <br />Manufacturer <br />*Model <br />Number <br />*Serial <br />Number <br />*NTEP CC <br />Number <br />(device or <br />component) <br />Type of Device <br />(capacity if applicable) <br />I(Z <br />6 art0 <br />IV t" <br />ENooa.395'Yj <br />Ca -oto <br />C17 a-5 <br />'jtM <br />(q;Apreo <br />NII <br />tFAloo12rsga- <br />D'-'0��' <br />fd <br />(?; l barro <br />N)V l <br />. 00] Si <br />0.1 -0A <br />-7iS <br />C ; I Pe -Co <br />IV (V <br />F 06 <br />Oa--o(cl <br />67 OL S <br />9110 <br />C,>t`a.rry <br />NL( <br />EIV 00l?r5V <br />01-014 <br />C,aJ F OSS` <br />u(t1- <br />6"14Cr4o <br />NL( <br />LN Oda WE <br />N_O(q <br />070-S 17 PSC <br />Remarks: <br />�J'04 <br />US <br />REQUIRED MFORMATION Reference: California Code of Regulations, Title 4, Division 9, Chapter 4, Section 4085 (a)(2) <br />Link to county contact information: <br />http://www.cdfa. ca.gov/exec/county/documents/countycommissionersealercontactinfo.pdf <br />