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De1Valle Co.
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MONTH DAY TIME DESCRIPTION OF WORK DONE
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TOTA L
No. Days at $ per d;i y, amo unting to
::..:::.L.::__ ____________ ------'-a:...::....t --"-$ ___ ._J_pe_r_d_a_,,_y.'---a_m_o_u_n_ti_ng=--to
No. Days ___ \ _ _ _ ___ _ ________ _
1 1 1
Less
L ess for
Amount due I
~---_..:...::..:...:.:...:.=::___::_:::..::.___ _______________________ , ___ 1 __ 1----1-----1-----
ApproYed by Recei ved Payment:
_______________ Supt.
