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by WORK ACKNOWLEDGEMENT FORM Received <br /> 12/27/2022 <br /> zZ s S <br /> E-MAINTENANCE TICKET NO. DATE . <br /> FACILITY NO.&ADDRES( 9,C) 2 lZ _ZV <br /> CONTRACTOR COMPANY NAME Gei ,er- yan Inc. <br /> SERVICE REQUESTED ON E-TICKET: <br /> 4 <br /> WORK PERFORMED ONSITE (for parts replaced,provide part name(s), part number(s) &quantities,as applicable): <br /> i /J X7f_r✓Y� 01/11i{-� G(JL �C �✓1- �y(c.Cr 'rlY` /r�. ,!-�i "1�.� G-( <br /> e Ivtc%�cr / Si <br /> r <br /> 5' <br /> WAS THE REQUESTED WORK COMPLETED?(circle one) SES NO <br /> IF NOT, ESTIMATED RETURN DATE? AND PROVIDE DETAIL BELOW ON WHY <br /> a r1.e S� -6L .-I— 2 <br /> ARRIVAL TIME ',�c'� f1.� DID YOU CHECK INTO THE BP IVR?(circle one) NO <br /> DEPARTURE TIME o] ) DID YOU CHECK OUT OF THE BP IVR?(circle ane) \YFrS NO <br /> NO.OF PERSONNEL ONSITE2). 'C74,'/ ;�� �& <br /> I <br /> TECHNICIAN NAME (PRINT LE IG BLY) SITE PERSONNEL(PRINT LEGIBLY) <br /> TECHNICIAN NAME(SIGN) §ITE PERSONNEL(SIGN) <br /> DISTRIBUTION:WHITE-CONTRACTOR COPY / YELLOW-SITE COPY <br />