Page 3 - delvalleco1919

Del Valle Co. CJ ...
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For Labor done during the Month oL .. ,, ............... , ..................................... .19 . ., .. , ... , 0
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MONTH DAY TIME D~§CRIPTJON OF WORK OONE
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TOTAL
No. Days
No. Days
Less ~

Less for
Amount due

Approved by Received Payment:

............................................................................................ Foreman ( Sign Here) ........................................................................................ .

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.......... ..... ......... ..... .. ......... ................... ........ ....... ..... .. . .. . .... . ... .. . ... .. ... .. . . . . .. . ... .. ... ----............................................................................ ---....................... -...................................... ----............................................................................. ---................... -........ -.......... -.