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A <br /> AtlanticRichfieldCompany „ Work Acknowledgement <br /> SN <br /> Location <br /> L..oulsE R\iE . <br /> &hgD <br /> Facility number <br /> Ubo <br /> Contract work order or authorization number <br /> OZ-7Z <br /> CAH �s3 <br /> On CJ work was done at this <br /> Date <br /> location by: <br /> 5c(A7 CC) , <br /> Contractor nam <br /> ;s• I Address <br /> The contractor had 1 personnel here for approximately hours <br /> .t. <br /> and worked on: <br /> L� N� �r�t <br /> Signa u of deal 6"r-hid 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-n) <br />