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AtlanticRichf'reldCompan-' ;; Work Acknowledgement <br /> l ' 111�/ e7 <br /> Facility num r <br /> � n <br /> Contract work ordIrr or authorization number <br /> r <br /> On -� ' ��- `� / work was done at this <br /> Dale <br /> location by: <br /> Conlracto name <br /> Address <br /> The contractor had L personnel here for approximately hours o� <br /> and worked on: <br /> r r <br /> i <br /> e'll <br /> Sigh-a-rur-elot r or his employ 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 signatu.e. 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-n) <br />