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AtlariticRichfieldCompany „ Work Acknowledgement <br /> Location <br /> Facility number <br /> ZI <br /> Contract work order or authorization number <br /> On 1 `_\ work was done at this <br /> Date <br /> location by: <br /> LO <br /> Contractor na e <br /> Address <br /> The contractor had Z personnel here for approximately hours <br /> and worked on: <br /> r r. <br /> Its'f1�1.i r1�,►1 CA I°'�t-e- ��`-Q-;=i°C -� <br /> ignatur t aler is empioyee 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 />