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M"%-ry rfvuul.w %.0vil slily 7, <br />VENDOR NAME <br />ADDRESS <br />CITY <br />STATE, ZIP CODE <br />SERVICE REQUESTED: <br />SERVICES ACTUALLY PERFORMED: <br />PARTS <br />VVVr11\ Hl►r\I4VVVLCUu1VICIV 1 A 9 7 7 215 <br />DATE: <br />FACILITY #: CO AUTH #/JOB' ORDER: <br />LOCATION: <br />�roC,�d�i\� CGst <br />NUMBER OF ARRIVALS AS OF DEPARTURES AS OF <br />PERSONNEL CHECK IN CHECK OUT <br />TOTAL TRAVEL LESS MEAL TIME TOTAL LABOR <br />TIME <br />FOR NON -LESSEE / CONTRACT DEALER USE ONLY: <br />❑ MAINTENANCE VENDOR (Attach white copy to invoice and mail to technician.) <br />❑ LIGHTING <br />❑ LANDSCAPING / FLOOR / PEST CONTROL VENDOR <br />❑ FIXED COST (Dispensers, General Contractor, Signage) <br />PRINTED NAME OF DEALER <br />OR STORE MANAGER/EMPLOYEE: <br />SIGNATURE OF DEALER <br />OR STORE MANAGER/EMPLOYEE: <br />SIGNATURE OF DEALER (OR STO <br />DONE. CONTRACTOR IS RESPON: <br />FACILITY STAMP <br />AL0�,� � A <br />DATE: <br />MANAGER) DOIS NOT OBLIGATE DEALER IN ANY WAY, NOR DOES IT SIGNIFY ANY APPROVAL OF WORK <br />_E FOR FILLING OUT THIS FORM AND OBTAINING SIGNATURE. <br />APC -3316 (10-95) Distribution: White: - Attach to invoice Canary - Left at location Pink - Vendor's copy <br />