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<br />
<br />RequIsition Number
<br />
<br />V9ucher Number,
<br />
<br />APPROVED:
<br />
<br />Quantities AccePt~d
<br />
<br />.,i.:
<br />
<br />Date Received
<br />
<br />Received At
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<br />I.
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<br />Purehase Order No.
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<br />RECEIVIt ] REPORT
<br />/ ,.j ~ .. .STATED~<.;OLORADO .,'.';
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<br />,'._~/.' '- DEPARTMENt NSTITUnONORAGENCY
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<br />, ADDRESS
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<br />Fund Number
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<br />Supervisor
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<br />~~P~IO!"O!~lClesorSen.'!'?8S~~~Uy'R~el~~ i,
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<br />exceptions Noted
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<br />I hereb'ycertlfythat I have received the artlcles"lIsled above, that I have carjOlfuUy Inspected, weighed,
<br />counted.or measured the commodltlea and found them In-good conditlo'n and complying with the
<br />apeclflcatll:m., glv8n, ort~at th8 servlc~8 were satisfactory, except aa noted.
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<br />R~elvlng Clerk or AuthoTlzi;ld Employee
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<br />VJa;Fr't D Exp.DP.P:OTruck DOther
<br />395-51000.1227
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