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AtlanticRichfieldCompany „ Work Acknowiedgemit <br /> a� X <br /> LDc2bon <br /> CJSeIV), 7/ /,` <br /> 7C <br /> Faarty num&-r <br /> b�J?_5 <br /> Contract work oroer or auvuxuatton numoer <br /> On work was done at this <br /> Date <br /> location by: <br /> Contractor name <br /> Mdress Q <br /> The contractor had- personnel here for approximately V hours <br /> and worked on: <br /> r rte. <br /> ZeQ <br /> Signature of dealer or his employee Date <br /> Signature of 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.CO.•1499 <br /> (7-77) <br />