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❑CHECKED REQUEST FOR QUOTATIONS NO. PAGE 1 OF <br /> SO% ©ORDER FOR SUPPLIES OR SERVICE§ SB RETURN COPY(IES)OFTHIS QUOTE BY :Ntkek a <br /> APPLIES (THIS IS NOT AN ORDER.See DD Form 1155,) <br /> S.CERTIFIEDFOR NA <br /> TNGR DEFENSE UNDER <br /> 1.CONTPACTIPURCX ORDER NO, 2.DELIVERY ORDER NO, 3.DATE OF ORDER d.REOUISITIONIPURCM REQUEST NO. OMS REGI <br /> TSO4350000 DLA00587FO368 17 .JUN ST 71673027 DO <br /> B.ISSUED BY: CODE - J 7.ADMINISTERED BY:(If other than 6) CODE S.DELIVERY FOR <br /> BASE PROCUREMENT BRANCH DEST <br /> OPERATING MATERIEL DIVISION ❑ OTHER <br /> DEFENSE DEPOTTRACY <br /> TRACY CR 95376 5e S h dule UaMerl <br /> B.CONTRACTORIQUOTER CODE I <br /> FACILITY CODE 10.DELIVERTO FOB POINTBY: 11.CHECK IF BUSINESSIS <br /> r SRN JOAQU I N LOCAL HEALTH DIS 17 JUN 87 <br /> El SMALL <br /> El SMALL <br /> NAME AND 12.DISCOUNTTERMB DISADVANTED <br /> ADDRESS P G BOX 2009 � ❑ WOMENOWNED <br /> L STOCKTON CA 95201 J 13.MAIL INVOICES TO: <br /> �( SEE BLOCK 15 <br /> 16.SHIP TO: CODE _ 15.PAYMENTWILL BE MADESY: CODE <br /> SUPPLY BRANCHACCOUNTING o FINAI MARK ALL <br /> MF: WHSE 7-2 S133200 DEFENSE DEPOT TRACT' PACKAGESAND <br /> TH <br /> DEFENSE DEPOT TRACY CONTRACTOR <br /> 87FO368 TRACY CA 95376 ORDER NUMBER <br /> TRACY CA 95376 <br /> 111-0-2 <br /> DELIVERY This delivery code is subject to instructions contained on this side of form only end is issued on another Government agency or in accordance with and subjectto <br /> terms and conditions of above numbered contract. <br /> Reference your furnish thrfollowing on terms specified herein,including,far U.S.purchases.PURCHASE <br /> General Provisions of Purchase Order on OD Form I ISS,IEXCEPT CLAUSE NO. 11 APPLIES ONLY/F THIS BOX ❑ /S ACKED, AND NO. 11/F THIS BOX ❑ <br /> 1S CHECKED/;special provisions ;and delivery as indiuud.This purchase is negotiated under authority of <br /> 10 USC 2304K)(3)or as specified in the schedule if within the U.S.,its Possessions or Puerto Rim:if otherwise under 230ga)(6). <br /> ❑ prheckrd.Additional General Provisions a➢➢IY:Su➢➢tier shallsign"Arra➢ranre"on DDFc ns1jjSr Prdrmurn ro➢ies. <br /> 17.ACCOUNTING AND APPROPRIATION DATMLOCAL USE <br /> 01 9770100 5132 001 P900 26 .04549 498. 0{Y..�y,) ;1 4 <br /> 18 ITEM NO. 19 �i 'J SCHEDULE OF SUPPLIESISERVICES 20 QUANTITY <br /> 21. i2 UNIT PRICE 23 AMOUNT <br /> J ' ! I� I � OUANTITY <br /> V IF6 PART NUM ACCEPTORD AED <br /> r� <br /> 0001 71673027 FEES 9999007161037 01 1 LO 490. 0000 490. 0 <br /> FEES FOR 1987 PERMITS TO OPERATE <br /> DEFENSE DEPOT TRACY UNDERGROUND TANK <br /> FACILITY, CONTAINERS 1 THRU 14 (PER <br /> RSSY BILLS 1362 (SHER) AND 2013 PA—"MF—NT <br /> (CORTESS). RE EIVED <br /> FOR PAYMENT ONLY. JUN 2 31987 <br /> REFER ALL ORAL INQUIRIES TO SONYA R. ENVIRONMENTAL HEALT <br /> BAIRD, AREA CODE 209 832-9095. REFER PER ITISERVICES <br /> a <br /> 26.LPJITED STATES QFfM A 11,TOTAL <br /> a/Iantityryanrdindic Mr Governmem is same -- -'aaP — <br /> 0.r vaanrn ordered indicate by rmark.0 DUPLICATEORI^.INAL 2B. <br /> dlJercnr,amernrmalquam ly.phP bemw <br /> quanNryocdenM and encircle BY: CONTRACTING OFF;b.�(ZCTINGIORDERING OFFICER ENCES <br /> 26.QUANTITY IN COLUMN 20 HAS BEEN: 27,SHIP.NO, 28.D.O.VOUCHER NOT.. ^ n 30. <br /> ❑INSPECTED ❑RECEIVED ❑ ACCEPTED NAND OTED CONFORMS TO THE CONTRACT INITIALS <br /> ❑ PARTIAL 32.PAID BY 33,AMOUNT VERIFIED CORRECT FOR <br /> ❑ FINAL SN-5012 <br /> DATE SIGNATURE OF AUTHORIZE—GOVERNMENT REPRESENTATIVE 31.PAYMENT N.CHECK NUMBER <br /> 30.I curtly that this account Is correct end proper for payment. G pMpLETE <br /> ❑ PARTIAL JUN 191987 35.BILL OF LADING NO, <br /> DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER []FINAL <br /> 37.RECEIVED AT 38.RECEIVED BY 3�TEtE[SEV F'-" 1E T�fAL{ I E a am Qz— 62,S/R VOUCHER NO. <br /> MA <br /> 0D FzsEP 1165 PREVIOUS EDITIONS ARE OBSOLETE. 16{Sd7 9E T E <br />