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H&M —BW#98 <br /> 2501 Jackson Ave. Escalon CA 95320 PR0231488 <br /> 7/11/24 <br /> PHOTO#3 <br /> p Billable <br /> p Factory Warr. <br /> 3697 N.Valentine Ave.*Fresno,CA93722*(559)444•1 p COD <br /> ' License No.779267*AN EMPLOYEE OWNED COMPANY <br /> S v p Not Billable <br /> S Please Visit Our Website:www.lcservices.com O Bid Job <br /> PETROLEUM MAINTENANCE CO. <br /> FRESNO,CA <br /> e sx N2 136085 <br /> Name: Date: t�f-•� <br /> Service Z I G <br /> Address: ip:"I�-52' Phone:- worltorder# <br /> Z <br /> City: cust.r.o# <br /> Dispenser Make close contir.# <br /> Dispenser Model: <br /> Purchase Drder# <br /> Dispenser Serial#: <br /> Dollar Amt: <br /> Pump Test:Gallons: <br /> Description of Work Performed <br /> G r <br /> e <br /> a ��- <br /> ca - <br /> � I give authorization to LC Services <br /> Print Name <br /> Signature&Dat z to run my credit card as form of payment. <br /> wuh re�onsideb a5'/5WnmueWb9leenmY�m bmsgneaNaNim paryvmmmor+.sM1WArvnbem*n'ercen <br /> imeWWseB�mmem NegeNngOeM eWlnemWM bmasonaWselNmeyabmeM NeGWMylsmLon Card#• <br /> ��m�F,�r.��n.NbM,.msavNrao.m,rmaagu»roNm.�nrmdmmemnm�,�rv,nroam <br /> mn.-munmmeumnwrmanoei ooWauo,mN.aaamem. Card Type: Billing Zip: <br /> nrummu�umgaM1uasoaesatw.�slameem,rc:�,mw+ .�w�ra.::g�a.w�w.e mw.Wanana.nuweda p - <br /> Ex Date: /_/ 3 Digit Security Code• <br /> iwc,m.�N�vnme.mo,maoe.am.as.se m.raunw�ara.Hama mmonm�a��mml. <br /> u,:aWamaroM�.w,� nesdn.mrwwaaarei:nxm:xi wa.a�oea,�ine<emma,em�maWai�wwa Name on Card: <br /> rMy�o„aa�ymm..m��wm�omaa,ImapanW.iawmmeare rnN..aszrm.:�a�,ma,resaroNaw...... Work Authorized by Date <br /> ra rI.nlMNmmemu�w:NNeaneol�.e pmw. Signature <br /> Qty Part No. Inv. Description&SIN Each Amount <br /> Loc# <br /> Wor r Date Depart Arrive Depart Stop O/T <br /> p Total Labor <br /> Z: Total Parts <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br /> IMG_0235 <br /> Lynsey Sammons, EHS Page 4 of 9 <br />