|
<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 />Purehase Order No.
<br />
<br />I
<br />\,
<br />
<br />RECEIVIt ] REPORT
<br />/ ,'I ~ " 'STATE.o~<.;OLORADO ,,0";
<br />",f':r;::U "UJ a,,',JL_ [~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 .,.{< 'Yt-'?o/~)<-r., '~>1nA1 i;-/ r!yl " iit.,...., '" f't1 {A 1!f
<br />
<br />(tc~~,tJ;~))~:>; j I,~ 0~,j~; J "
<br />
<br />, 1yrs b~/~ lCf1D7)
<br />
<br />/dol " ,
<br />.? tj _ 0/1'" cJu
<br />. ,,'1 I y'
<br />/;'./) ;?'
<br />...~",
<br />
<br />;,r "" ~
<br />Uj/O
<br />
<br /> , /. "., 3 z
<br />(> ; ,- t:-' .#"')
<br /> -'
<br />
<br />~1?7/f7
<br />
<br />NO.
<br />
<br />"
<br />1'/' ...~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 />":.-)~~, '- ~ r'- (i"'}
<br />,.' "'t. \,~,,~: .. ; j.' /,','
<br />R~elvlng Clerk or AuthoTlzi;ld Employee
<br />
<br />, "
<br />VJa;Fr't D Exp.DP.P:OTruck OOther
<br />395-51000-1227
<br />
<br />, ,
<br />-;~~~:~-'':''::':''~' "..
<br />
<br />" ':-.
<br />:";..J;~.'~,:~..J:,~
<br />
<br />":;';0,,,.,::: ',.i':
<br />
<br />" '-'," - . ,.
<br />"?-:"'~i~..:.:..o-..;.:::.L..........z..;'i,:
<br />
<br />,.." ,... ~' "_~;,~.i.::-..........:._.___
<br />
<br />"'\'.' ~, ~ >,' 'c,,; ",' ,,:, ""
<br />
|