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<br /> <br />" <br />i~ <br />..:.1 <br /> <br /> <br />p,ejr <br />so <br /> <br />ac <br />lions, in <br />JOB NUMBER REQU ST FORM <br />~~O\\'\\\ <br /> <br />~, <br /> <br />~~~ (~-- <br />'* ReceivedS/," <br /> <br />~ <br /> <br />~~ <br /> <br /> <br />CLIENT LOCATION: <br />'ttC-llli~ &10 - 61<.C..k..e I( ~l<:lee::,ss. G. ~I ~ It:. 6ro12E." 0\ <en <br />~D f2.e~e\06E:.?\!"br2.~~ l'5Ol ~ ~r:>. <br />\AMp6- J ~ oo~fO ~taH.lLL~ ,-:L <br /> <br />CONTACT PERSON <br />F~ ~t--J\ <br /> <br />PHONE NUMBER <br />Bl~ - 144- c;;,~ <br /> <br />~L~ <br /> <br />RELEASE # <br />r.o.#: <br /> <br /> <br />ORJGINAL CONTRACT <br /> <br />BASE <br /> <br /> <br />. 1~ <br /> <br />^,-T" <br /> <br />TIrl <br /> <br />^,-TI03 <br /> <br />TOTAl <br /> <br />JOB DESCRIPTION <br />'REHo\,€;. <br /> <br />'41 <br />,L \<::;~ <br /> <br />!~ <br /> <br />CONTACT PERSON: "127- {Jf{{- tfLfo 7 <br /> <br />PHONE NUMBER ~1Z7- [(47- N/J <br />~ I'flift If <br /> <br />CHANGE ORDERS <br /> <br /> COHT1I.AoCT ESTI"""TEO <br /> AMOUNT COST WlRGlN $ WlRGlH 'Ilo <br />1 $ $ $ <br />2 $ $ $ <br />3 I I $ <br />. $ I I <br />TOT Al- l l l <br /> <br />(5cc.r: rtte <br /> <br />fd'e- ~hJ'\ <br />, J <br /> <br />SURVEY <br />LEGAL <br />TANK REG. <br />TAX FOLIO # <br /> <br />(r-f' (~ (4~j:;"Pl)!,\ <br /> <br />~/3 -'711- (((pI) <br />f , <br /> <br />INVOICE PROCEDURES:. <br /> <br />815 "7ac.. 00'2,0 <br /> <br />ACCOUNTING ONt. Y: <br /> <br />~ D <br /> <br />LUUP SUU T & U <br /> <br />ADMINISTRATIVE I SUPERVISOR: <br /> <br />NAME: <br /> <br />DATE <br /> <br />PAYMENT TERMS <br /> <br /> <br />PET PAC SOLUTIONS Representative <br />Tony F 'ck Branch Manager <br /> <br />ACCEPTANCE PETROPAC SOLUTIONS (Seller) <br /> <br />Signature of Officer <br /> <br />Title <br /> <br />Date <br /> <br />PosmON: <br /> <br />TIME: <br /> <br />Revised 1CYZ:3.W W:\WORKS\TYPING\JOBRQST -REV XLS <br /> <br />ACCEPTANCE: Upon acceptance by the purchase and acceptance of an officer <br />of seller, this document will constitute a bona fide contract subject to all the <br />terms and conditions on the reverse side. There are no promises, agreements, <br />or understanding. oral or written other than specified in this document. <br /> <br />Company Name (Purchaser) <br /> <br />Signature <br /> <br />Print Name of Signature and Title <br /> <br />Date <br />