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7" <br /> Atlantic Richf i eld Company Work Acknowledgement <br /> 64 L 1L Ut' <br /> AUG 1 2 1,991 Location <br /> ENVI RON MENI IFAL HEALTH 61 00 M qtol <br /> PERM IT/SERVICES <br /> Facility number <br /> Contract work order or authorization number <br /> 049/06 <br /> LV <br /> AUG 1 2 1,9,ql <br /> ENVIF()jV <br /> P= ME-NTAL GlcA <br /> On work *4C E S <br /> Date <br /> location by: <br /> Contractor name <br /> Address <br /> The contractor had y personnel here for approximately hours <br /> and worked on: <br /> S ,A-7 lb <br /> Sig6a re of dealer or his -Or—oyee(--- Date <br /> ignatur dealer (or employee) does not obligate dealer in any way, nor <br /> _does it signify any approval of any work done. <br /> Contractor is responsible for filling out this form and obtaining signature. Any <br /> invoice for work not covered by a separate contract at a firm price must be <br /> accompanied by a completed copy of this form. <br /> A.R.00,1499 <br /> (7-T7) <br />