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<br /> 05/09/2006 TUE 11; 24 FAX 541 682 8500 LANE COiINTY P\w DELTA ..~~.Z.Z [001/001 <br /> ~ S <br /> Y <br /> LAN ~ COUNTY <br /> ' • . ?ti •'r " PUBLIC WORKS DEPARTMENT / 3044 North De{ta Hwy. /Eugene OR 97408 <br /> Phone: (541)682-6900/ FaX: (541) 6a2-8500 ' <br /> F~4X COVER SHEFT <br /> DATE: ~ ~ ~ <br /> ~yCJ TOTAL PAGES INCLUDING COVER SHEET: <br /> ~ n ~ <br /> TO: _ ~ ~Qs ~ ~ V f - FROM: <br /> COMPANY:. l~C~t-, ~~r ~..~~'~Q~-~ SENDER'S PHONE No.: CF~S Z `C~ 7 O~- <br /> FAX No.: l~ ~ Z " a ~7~~ <br /> PHONE No.: <br /> _ . <br /> NOTES/COMMENTS: a- ,m..:_._..,,_...,,.,,,, <br /> To: <br /> g - Bottle Data <br /> Job No. ~ ~(2 3 <br /> C.omr No. <br /> IANE COUtITY PUBLIC HORK A~essable'~ S~ ~ NO <br /> 384@ t1 QEITA NW ~ ~ ro ~ <br /> ' EUBENE, OR. 97488-1636 <br /> TERMINAL I.B, : NB14H6Y S gnaturs rIt?tE3..,_,.... _-S D <br /> MERCHANT Mr 95D8144976 <br /> MC PCgR0 <br /> • X841 3 <br /> SALE ~Cl bJE~°~ <br /> BA1CH:8884D( IHVr 008881 <br /> GATE: PWY 04, 86 IIMEt 18:35 <br /> COST CODE: 123 AUiNr 013121 ) C~~J ~ r--) ~ ~r,l <br /> AU5 RESPONSE: N <br /> TOTAL 5300.00 t>,c~=~v=~~ C'vG~t~' <br /> • i 7 <br /> ' I AGREE 10 PAY ABODE 101A1 AMOUIIT <br /> gCCORDIH6 TO CARD ISSUER RGREEMEHi <br /> (MERCHANT AGREEMENT IF CREDIS VOUCHER) <br /> CUSTOMER CBPY ~ ~ . <br /> - - <br /> 05/09/2006 TUE 11:21 fTX/RX NO 69x391 ffi o~i <br /> <br />