Document xadzoQ9rDDOMy0NX7vON4ZDG

I. Contract Identification File No.: IMk ' Location(s): File Name: L .'A d^> &LL ! A- y ) ufub~ ^ ^(jrzru Work Description: djjsitLUtnA' Contractor: PfJ)^u4J PActr- ClT. ' Reviewer: Date: Location/Work Description Cont1: Ill. Employees A. Employees/Workers' B. Days worked CHARGE TO ADDRESS NAME Job -V. .* TASCO INSULATION INC. office o-angstowr Thir-an ('.instruction-Co'. 'Poland, Ohio `V Park Ave. Bldg. St. Et8 Hosp. ACMOONUTNRATCOTF S300 00 date___ 1-17-S4 BUJNGS DATE AMOUNT t')\-U 3&0 (70 PAYMENTS DATE AMOUNT 6 location_____ Youngstown, Ohio_____________ _____ WORK TO BE DONE Tnmilate. ductwork ' DATE DESCRIPTION OF ITEM (7 MATERIALS /? 77 5? &FCRAERIGTAHGTE <3-7 V LABOR &BTORAARVDEL FRNGES EXMPIESNCS. E TOTAL 9? 7K> 9* ro /Y 33 flfc! / 737 < * ' CUSTOMER'S ORDER No. CUSTOMER'S JOB No____ ... NY 9846CONTRACT RECEIVED Tf .SCO INSULATIONS, If. C. ITEM QUANTITY SHIPPED QUANTITY OROERED DESCRIPTION OF MATERIAL &&1. UNIT PRICE EXTENSION TOTAL Zoo * u 4*. *0)l j<L" Duct*,** r0__ ,// ---- / iw )\ 3 c/ f<? / L T& 7ft -- ----_________ -------------- -- ssb / L1 La ddo-4 / C.j\ A\V\ L o O k___________________ 0( S ,/ J .ft