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<br />
<br />RequIsition Number
<br />
<br />V9ucher Number,
<br />
<br />APPROVED:
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<br />Quantities AccePt~d
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<br />.,;,:
<br />
<br />Date Received
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<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 ~ '. 'STATE.o~<.;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 />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 />395'51008'1227
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