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.i Vi w 1�'r " <br /> .d RL.L <br /> TRAG"i OR <br /> B No 07'34-0197 3 <br /> spires Jul 31, 1989 <br /> ¢ 5.CERTIFIED FOR NA- <br /> CH ORDER NO. 2. DELIVERY ORDER NO. 3. DATE OF ORDER. 4. REQUISITION/PURCH REQUEST NO. TIONAL DEFENSE Ute- <br /> -r <br /> DAAC2190P0066 10/02/89 W62G2992708705 DER DMS REG l <br /> DO 51 <br /> &:" ISSUED BY CODE W62G2S 7. ADMINISTERED BY CODE SDSSHOCA <br /> 'SHARPE ARMY DEPOT --_ - &DELIVERY FOS <br /> DIRECTORATE OF CONTRACTING SHARPE ARMY DEPOT IXl DEST <br /> LATHROP, CA. 95331-5108 DIRECTORATE OF CONTRACTING 13 OTHER <br /> ADMINISTRATION DIV, BLDG S-4 (see schedule <br /> GERI FIORE (209)-982-2423 LATHROP, CA 95331-5108 if other) <br /> 9. CONTRACTOR CODE 00010249 FACILITY CODE 10.DELIVER TO FOB POINT BY 1i.MARK IF BUS. IS <br /> 10/02/39 IXI SMALL <br /> NAME AND I I SMALL DISAD- <br /> ADDRESS SAN 30AQUIN COUNTY PUBLIC 1 :. DISCOUNT TERMS VANTAGED <br /> HEALTH SVCS/ENV. HEALTH DIV. 0 I 0 Net 30 13 WOMEN-OWNED <br /> P.O. BOX 20009 <br /> STOCKTON, CA 95201- 13. MAIL INVOICES TO <br /> EE BLOCK 15 <br /> 14. SHIP TO CODE EPO 15. PAYMENT WILL BE MADE BY CODESDSSARFA MARK ALL PACKAGES <br /> EPO, BLDG. S-4 F&A OFFICER, SAAR AND PAPERS WITH <br /> SHARPE ARMY DEPOT SACRAMENTO, CA 95813-5013 CONTRACT OR <br /> LATHROP 'CA. 95331-5106 SUBMIT INVOICE IN QUADRUPLICAT ORDER NUMBER <br /> 16. DELIVERY This delivery order is issued on another Government agency or in accordance with and sub;ect <br /> to terms and conditions of above numbered contract. <br /> PURCHASE X Reference your, BILLING STATEMENT ATCHD furnish the followin4j on terms Specified herein. <br /> ACCEPTANCE: THE`CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BED, <br /> QE;IS hlt?W�MOAFIED,_SU$JEGT T ALL OF TFC TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME. <br /> NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED <br /> If this box is marked? supplier must sign Acceptance and return the following number of copies: <br /> 17. ACCOUNTING AND APPROPRIATION ARTA/LOCAL USE <br /> 21X4992.06PR 6P-1571 SO4170 PCN:5DC605 CCC:3A400 <br /> 18.-ITEM NO. 19. SCHEDULE OF SUPPLIES/SERVICE 26.QUANTITY 21. 22. UNIT PRICE 23. AMOUNT <br /> ORDERED/ UNIT <br /> ACCEPTED* <br /> SPECIAL ATTENTION', Read Block 15 care- <br /> fullyyR it is important to indicate your <br /> purchase order number on your invoice <br /> f r.;prompt payment. <br /> 1 UNDERGROUND STORAGE TANK FEES FOR 1 JB 1072.750000 1072.75 <br /> SE <br /> �RVVICES IN CALENDAR YEAR OF <br /> �s.k ..-+✓ .,vt°� iX'F.mr;.r 1988 ,:... <br /> *If quantity accepted by the Government 24. UNITE T ES OF AMER z 25. TOTAL 1072.75 <br /> is same as quantity ordered, indicate <br /> by x. If different enter actual &ero,129. <br /> quantity accepted below quantity IFFERENCES <br /> ' ordered and encircle. BY: CHARLES R. ARNOLD CONTRACTING/u-" OFFICER <br /> 2b. QUANTITY IN COLUMN 20 HAS BEEN 27. SHIP. NO. 28. D.O. VOUCHER NO. 30. <br /> 13INSPECTED [ 1RECEIVED I ]ACCEPTED AND CONFORMS TO THE INITIALS <br /> CONTRACT EXCEPT AS NOTED [ I PARTIAL <br /> I l FINAL 32. PA"Tib I y 4 AM VERIFIED CORRECT FOR <br /> DATE SIGNATURE OF AUTHORIZED GOVERNMENT REP. 31. PAYME14T <br /> 36.1 certify this account is correct and proper for payment I I COMPLETE 34. CHECK NUMBER�CT <br /> I I PARTIAL <br /> 35. <br /> DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER I I FINAL BILL OF LADING NO. <br /> EV'./IROrWtNTAL HEAM' <br /> 37. RECD AT 38. RECEIVED BY 39.DATE RECD 40. TOTAL CONT. 41. S/RPAffiMfWRWFP 42. S/R VOUCHER NO. <br /> DD Foam 1155, JUL 87 Previous editions are obsolete. CONTRACTOR MUST SUBMIT FOUR COPIES OF INVOICE <br />