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,Unocal Petroleum Products <br /> ii:Chemicals Division <br /> Unocal co rcrat n <br /> 4y 911 Wilshire Blvd..Suite 1128 <br /> r` lis Angeles.Catifcrria 90017 Work <br /> A {, <br /> ie!2phcne(213)977-5(213)977-5389 862 Y T o rk HC R n o W t I ed g e m <br /> A" 761 <br /> HEALTH <br /> ° <br /> :M g, <br /> 't.ti ��ielro t.xaxri <br /> 93 OCT 22 PM 2: 14 <br /> ra^2Y rur.-->er <br /> Ca:.a wore o.er or L=.x�a:cn r�:r�,er <br /> On <br /> wcek was d: <br /> Qat <br /> by.: <br /> �_u. <br /> Cert actor name <br /> I;dress <br /> The contractor had—L---P--rsonnel here for approximately hC' <br /> and worked on: <br /> Srna::re of neater cr hes er noir_ Cate <br /> Signature of dealer (or employee)does not obligate dealer in any way,nor <br /> does ii signify any approval of any work done. <br /> •Co,ntractor is responsible for filling out this form and obtaining sicnature.A.-,y <br /> invoice for work not covered by a separate contract ata firm price r ust ir_ <br /> accompanied by a completed copy of this form. <br />