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I%I'P11T%C33 NHERE0F the Parnas hwe amcured dais 03= Al reen.enl is Y the Etfertive <br />Dale <br />Customer: <br />Authorized Rapresentative <br />Title: <br />Signature: <br />Date: <br />Business Address, <br />Tsiephono No. <br />Fax No. <br />E -Mail Address:: <br />RECOMME4IDED FOR APPROVAL <br />Southern California Edison Company: <br />Authorized Representative <br />Title: <br />Signature, <br />Date: <br />Business Address: <br />Telephone No. <br />Fax No <br />E -Mail Address: <br />ATTEST <br />Francisco Gutierrez, Exec. DIr. Maria D. Euizar, Clerk of Council <br />APPROVED AS TO FORM: (for purposes of sample form only; vAll need re -approval upon completion) <br />JtfHN M. FUNK <br />Assistant City Attorney <br />Form 14.914 <br />0412016 <br />25B-18 <br />4 <br />