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PAGE 1 OF <br /> REQUEST FOR QUOTATIONS NO. <br /> CHECKED <br /> Box ®ORDER FOR SUPPLIES OR SERVICES RETURN coavufsl OF rH15 QumE By <br /> APPLIES /THIS IS NOT AN ORDER.SEe DD Form 11651) 5.CERTIFIED FOR NA. <br /> TIONAL DEFENSE UNDER <br /> 1.CONTRACT/PURCH ORDER NO. T.DELIVERY ORDER NO. 3.DATE OF ORDER ..REQUISITION/PURCH REQUEST NO. 0M5 REG 1 <br /> DO <br /> DI <br /> @'Y. <br /> C <br /> 45 <br /> BMIN <br /> .ISSUED BY CODE 1.ADIBTFREO AT (//pehrr than BJ .- CODE 1 °.DELIVERY FOB <br /> GEST <br /> BASE PROCUREMENT BRANCH <br /> OPERATING MATERIEL DIVISION ❑OTHER <br /> DEFENSE DEPOT TRACY Bnheaalr if the') <br /> B.C N A M1 /OUOTER I;A95-"76CODE FACILITY CODE 10.DELIVER TO FOB POINT BY 11.CHECK IF BUSINESS IB <br /> WALL <br /> WAIL <br /> r SON .JOAQUIN LOCAL HEALTH D� DJLADVANTAaED <br /> NAME AND I}.D16Cd1NT TfRMB WOMEN.OWNED <br /> AOOREtl 5�..-�Z^.. L:4171�1 pTM1B.1 <br /> mm p <br /> P. 0. BO.( 2009 13.MAIL INVOICES TO. <br /> L STOCKTON CR 95201 <br /> SEE BLOCY. 15 <br /> 14.SHIP TO: CODE IS,PAYMENT WILL BE MADE By CODE CTe-4549 <br /> SUPPLY BRANCH ACCOUNTING & FINANCE DIV. FAMARINKBA ALL <br /> MF: WHSE 7-2 SS3200 86P1831 DEFENSE DEPOT TRACY �*�%"TON <br /> ORDER NUMBER <br /> DEFENSE DEPOT TRACY TRACY CA 95376 <br /> 1° This defiYeri,order is subject to Instructions contained on this side of form only and to Issued on Emoalo OovemR t ABASS'As In .A.R1th and wb}m <br /> DELIVERY to t—and conditions or eboa numbered contrast. <br /> oz <br /> ¢ flefeeema Your fumble the folky"it"on Memo epslCed helNo,Ineludh1/.for 11.8.Pwe . <br /> HO PURCHASE <br /> APPLIES ONLY If THIS 80X 18 CHiCEED,AND NO. Id IF THIS BOX <br /> Oemael Pvua ioof Purdo.Order on DD Form 1155,(EXCEPT CLAUSE NO. 1T <br /> m ❑ <br /> IS CHECKED);apcial prcYuioa ;End deliva,AS Indk d.'111b pub.Y AgotlEted under nOAdeT of <br /> 10 UBC 231041EK8)or Mi ASCII In the achedub if Fridto the U.S.,it.pyeaeuioar or Doti.Niro;if othevbe under 8804(.)(6). <br /> ❑I/CMCheA,Additional Daniel Prouuioa Apply;Suppler shall W p, "Aecepfancr"on DO Foran 1165,And nfurn C.PNA <br /> tr.ACCOUNTING AND APPROPRIATION OATAILOCAL USE <br /> 01 9760100 5132 001 P900 25 504549 2638. 00 <br /> I°, tB. M1. QUANTITY <br /> ITEM NO. SCHEDULE OF SUPPLIESISERVICES ORDER EDI UNIT UNIT PRICE AMOUNT <br /> ACCEPTED* <br /> )OCUMENT NOUN NSN/MFG—PART—NUM ACC <br /> 0001 51153045 SERVICE 769900TI43167 31 1 JO 2630. 01x00 : 2638. 00 <br /> OB SERVICE, NON PERSONRL — FEES--FOR <br /> ERMIT TO OPERATE AND REMOVE DEPOT <br /> WNED EQUIP (UNDERGROUND TANKS) PER <br /> OV CODE (SESSION 5100 ET SEQ}: THEAD <br /> I Il 1`, q r�AWMENT <br /> —'ALIFORNIA CONSTITUTION, ARTICLE XI 11�AND REVENUE AND TAXATION CODE L ( UT <br /> SECTION 2201 ET SED?. IN <br /> OR PAYMENT ONLY. �✓ L L��L "'I <br /> A/f quantity aeC ptid by the Dowmmen(u Mw 34 UNITED STATES OF AMERICA ]°.TOTAL 2638, 00 <br /> CA quantity oldemd,indicate by N/mark. If M. <br /> dif/mL enter actual yuimbly saplyd Mi.. DIFFER- <br /> quantity ordeKd and enr;mle. Y CO TRACT 4G F I r_. ••} eTRACTINGIORDE RING OFFICER ENCES <br /> M.QUANTITY IN COLUMN M HAS BEEN: 31.SHIP.NO M.DO VOUCHER 3589 3U <br /> INITIALS <br /> C]INSPECTED 11 RECEIVED —] A Col EKCEPrEAS NOTED NFOflM°TO THE CONTRACT <br /> ❑PARTIAL 33,PAID BY 33.AMOUNT VERIFIED CORRECT FOR <br /> FINAL _� <br /> 1f/�'O,��'. <br /> OATS SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 3t PAYMENT W N C 1 t ° 518 <br /> 36.1 gena,Inlr__..o cmrtn eM"nor,for on—, ❑COMPLETE l! <br /> ❑PARTIAL MAY 02"W" <br /> BILL OF LADING NO. <br /> GATE SIGNATURE AND TITLE OF CERTIFYING OFFICER FINAL <br /> 31.RECEIVED AT M.RECEIVED By 38.DATE RECEIVED M TOTAL CONTAINERS 41 SIR ACCOUNT NUMBER B 42 SIR VOUCHER NO. <br /> MBS rS�p <br /> DD@RM IIW PREVIOUS <br />