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De Valle Co. To ____ c=-) ____..;..-=.,:Q~.3.c::WA!:.LJ· ::.3:;:L-.-=-_____ Dr. o
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For Labor done during the Month of ,f}-4 ~ ~ 1/ 192,_1 C
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MONTH DAY TIM .E DESCRIPTION OF WORK DONE
1
2
3
t,__ _ __ --l---1-----1------- _____________________________ __j_ __
4
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5
6
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9 J
10
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No. Days at $ per da y, amounting to I ')I I TOTAL I
-=-=-=--1--1---1--
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~--=N_:_:_0~.~D:::....:::a:..Ly~S ____________ ...:::::..at:........:$~ __ ____c...:pe~r-~d~aj,c...:..'• _a_m-'--ou=--n-'-ti_ng"'---"-to ______ ___ _____ __ _
1 1 1 1
Less
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Amount du e { (
Approved by Received Payment:
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______________ Foreman (Si gn Here) _____ \ .:,--_\ __ --=Nc....:::..........- _~_·_ l __ J1---
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______________ Supt.
1
