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OBRA:______________________________________________________________

DIRECCION: _________________________________________________________

PERSONA DE CONTACTO: _____________________________________________

TRABAJO A REALIZAR:
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

OBRA:______________________________________________________________
DIRECCION: _________________________________________________________

PERSONA DE CONTACTO: _____________________________________________

TRABAJO A REALIZAR:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

OBRA:______________________________________________________________
DIRECCION: _________________________________________________________

PERSONA DE CONTACTO: _____________________________________________

TRABAJO A REALIZAR:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
OBRA:
DIRECCION: TELEFONO:
PERSONA DE CONTACTO:

TRABAJO A
REALIZAR

OBSERVACIONES:
ARLEX BOTINA
Contratista

FECHA OBRA MOTIVO DE LA VISITA VALOR DE LA OBRA CANCELADO FIRMA

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