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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 <br /> <br />" <br /> <br />I. <br /> <br />Pureh&8e Order No. <br /> <br />I <br />,. <br /> <br />RECEIVIt ] REPORT <br />/ ,'j ~ '. 'STATE.o~<.;OLORADO .,.."; <br />",f':r;::U .' UJ 1'2">-'- [~d'"YI,~~? /1:;'6> <br />,"-~/.' '- DEPARTMENt NSTITUnONORAGENCY <br />'/", ... Wl /J' <br />/1 ,,/~ 1, . J >v#f"'~v. .~ <br />~~# t1ia <br /> <br />, ADDRESS <br /> <br />// <br /> <br />Fund Number <br /> <br /> <br />Supervisor <br /> <br />.U,nlt <br /> <br />~~P~IO!"O!~lClesorSen.'!'?8S~~~Uy'R~el~~ i, <br />", , <br /> <br />,-" J. i. <br />l/ ; t .,.{< .Yl-,?,/~)<". '~>1nA1 i;-/ r!yl .. i".,,,,, '" f't1 {A 1!f <br /> <br />(tc~~,tJ;~))~:>; j I.~ 0~,j~; J .. <br /> <br />. 1yr5 b~/~ lCf1C,7) <br /> <br />/dol '. . <br />.? t.j _ 0/1'" cJu <br />. ,.'1 I y' <br />/;'./) ;?' <br />...~", <br /> <br />;,r "" ~ <br />Uj/O <br /> <br /> , /. "., 3 z <br />(> ; .- C .#"') <br /> -' <br /> <br />~1?7/f7 <br /> <br />NO. <br /> <br />" <br />/,/' ...~r.~ ./", / <br />~',JI'_>/~'''''/' .,1".,/:' ...... <br /> <br />c. <br /> <br />t;' <br />1 <br /> <br />~<.(' ( <br /> <br />exceptions Noted <br /> <br />Pt~ <br />-7, - <br />/0 <br /> <br />. . <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. <br /> <br />":.,)~~, "~ r" (i"'} <br />.,' "'l. \.~,~: .. ~ ..:.' /.,.. <br />R~elvlng Clerk or AuthoTlzi;ld Employee <br /> <br />. .' <br />VJa;Fr't D Exp.DP.P:OTruck DOther <br />395-51000'1227 <br /> <br />. . <br />-;~~~:~-'':''::':''~' .,.. <br /> <br />" ':-. <br />:";..J;~.'~,:~..J:,~ <br /> <br />":;';0,,,.,::: ',.i': <br /> <br />" "'," ' . ,. <br />"?':"'~i~":':"';";.:::.L...........z..;"i,: <br /> <br />'-". ,... ~' "_~;.~.i.::-.........:._.___ <br /> <br />"'\'.' ~, ~ >,' 'c,,; ",' ,,:, "" <br />