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'e rl r -17--a <br />SEI OLEuMA�INiEN�tNCEfp <br />FPC511"p, CA <br />Name S ,� '5 /4 <br />Service3 <br />Addres/s�,,` <br />City l���'` <br />Dispenser Make <br />Dispenser Model. <br />Dispenser Serial #. <br />Pump Test. Gallons <br />3887 N. Valentine Ave. * Fresno, CA 93722 * (559) 4"1730 q---jtU u <br />Factory Warr. <br />License No. 719267 * AN EMPLOYEE OWNED COMPANY C� COD <br />Plaust Visit Our Wsbrite' www Icesrvics}s tom CZ1 Not Billable <br />M Bid Job <br />Sit N° 137979 <br />We Z <br />Zip Phone. M, order s <br />Cusl P a 6 <br />class count <br />PumhmOreer1 <br />Dollar Amt. <br />Description of NVork Performed <br />L60 LP51-AG <br />> OA ae <br />i <br />Signature &Dat <br />vo r M lwvwtr rr 1In;o w2ull Ir rwldr it r MW'+`I e / r.r pry b oirlvX Stil wi M pOrvrrioal <br />bwr""y <br />My e/ r twr �hti s f wria Lw+l Yr/ rr6! 1� � w e rry a!q!. h gyp/ b �alF �� s � a aaf aprr a <br />AN1 P,#w rrr, b t A rIw tirrc,r 1490Y t M Will <br />I CCAAW.AVO h ori a UMWY rr pn P� .90 n l dk1 a <br />,.,I"will *mrbv*A*0Op„M.,,.,,,"tol"wv„r,,,,,,,p,d,, <br />Lowarw. Fun” braMmwtcs.lilbill rlajmwA:...s..,all vMwommk&" <br />r!. t}d SIT! tl �alnarr/t, d 1/fll lv a �� /�/F�I. rtl roe!ir Y/!�u �a w,faL�cl r7 ohr I� O it*ml <br />IY I"dllr n mnrim rrr Mdtae pll <br />I, give authorization to LC Services <br />Pant Name <br />to run my credit card as form or payment. <br />Card#' <br />Card Type: Bitlirtg 7Jp: <br />Exp Date:�l�! 3 Digh Security Code: <br />Name onCard: <br />Work Authorized by Date <br />5i(jnature <br />A 3% CONVENIENCE FEE WILL BE APPLIED TO ALL CREDIT CARD TRANSACTIONS <br />Qty fart No. <br />Inv. Description & S/N Each Amount <br />Loc# <br />EVorker D to <br />Depart <br />Arrive Depart Stop O/T <br />CJa ,' f Total Labor <br />Total Parts <br />Mileage <br />Travel <br />Freight <br />Sales Tax <br />Total Amount <br />