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De Valle Co.
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MONTH DAY TIME DESCRIPTION OF WORK DONE
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o. Days at $ .., / per d;iy, amounting to TOTAL
No. Days at $ per day. amountin g to
1---1----- 1--
Less
Less for
Amonnt due
Approved by Recei,·ed Payment:
______ ,, __________ Foreman
________________ Supt.
