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H&M —BW#98 <br /> 2501 Jackson Ave. Escalon CA 95320 PR0231488 <br /> 7/11/24 <br /> PHOTO#8 <br /> - — ,Der.r.,r,-.._,•.... . - <br /> e rr. <br /> � Billab) �1/a <br /> 5 3887 N.Valentine Ave.*Fresno,CA 93722*(559)444 1730 p pactOYY <br /> 2 <br /> NN <br /> �y License No.779267*AN EMPLOYEE OWNED COMPANY � COD aple <br /> -`v, S O COt Bill <br /> PETROLEUM MAINTpNANCECO. Please Visit Our Webslte:WWW.Icse Nices,com <br /> FRESNo,Cq ty � Bid JOb <br /> Name: Z'\ /V �_� p(,J /6 SR 9�r17 � <br /> Service <br /> Address: '� r h/ )D r �c'r'n Data: —r <br /> City: Zr' l r Work Order# ' k N / 7-1 <br /> Zip: Phone: <br /> Dispenser Make cust.P.o# <br /> Dispenser Model: Close Conic �� <br /> Dispenser Serial#: PuronaseOrder# <br /> Pump Test:Gallons: DollarAmt: <br /> Description of Work Performed <br /> ._C r d <br /> �l <br /> Signature&Date I' give authorization to LC Services <br /> Prin[Name <br /> cerewmmu<r«<naae.orx<wma kenmr/uu+m•memb�WbetnUJp'<Aylw i<ero-sx.ia n�< e' to run my credi4 card as form of payment. <br /> om< mmlme-.sauq-'<mea•e--.a--Yareu.naureraunoiiunmi:eon Card#:mmyommwMw w� 1m� eeyennia,,«.,.r•••re�++a�anmmwny<myoymemarx��a« na <br /> �<s mpuvea'rymmuoi my/wrruawi•eGpumrow.wm<m.oc � <br /> eau Card Type: Dining yip; <br /> tiaorgonm<roweeny,u.<e,<mwm'=s«�mwi.erc�w.«w•,•• —ea <br /> m<nxgo�m<.auwa«e <br /> roum:,sa•,• ea w .< w rce�<nwo•ues••.•<«eceae<e•ms.,. Exp Date:_/_/_3 Digit Security Code: <br /> wes<ms•wwm+auParre»'.m<mcenc s«u«vinwrov<•n=•mve�mmm•ai.«<•ew,eee«<.y,•,wa«imgrea,mavare Name on Card: <br /> v�mw�•a�w+••y�me�emM.warorr�m.am,<p<mamwvo•c<•a e<im<..aw,.<ao,wmw<•�,rem«n•mm m<::ma< <br /> Work Authorized by Date <br /> Signature <br /> Qty Part No. Inv. Description&S/N Each Amount <br /> Loc# <br /> rc <br /> t � <br /> Worker Date Depart Arrive Depart Stop O/T <br /> Q PC) I 'r D Total Labor <br /> Total Parts <br /> Mileage <br /> Travel <br /> Freight <br /> Sales Tax <br /> Total Amount <br /> I M G_0240 <br /> Lynsey Sammons, EHS Page 9 of 9 <br />