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' -ORDER FOR SUPP'L I ES' OR SERVICES � Form Approved <br />PAGE 1 OF <br />OMB No. 0704-0187 <br />8 <br />Expires Jul 31, 1989 <br />S.CERTIFIED FOR NA - <br />TIONAL DEFENSE UN- <br />DER DMS REG 1 ' <br />11. CONTRACTRURCH ORDER NO. <br />DLA00591M9136 <br />12. DELIVERY ORDER NO. <br />3. DATE OF ORDER, <br />06/12/91 <br />4. REQUISITION/PURCH REDDEST NO. <br />SB320011237002 <br />110 Sl <br />6. ISSUED BY CODE DDRW-ADM <br />DIRECTORATE OF CONTRACTING <br />DEFENSE DISTRIBUTION REGION <br />WEST, ADMIN. DIV. BLDG S-4 <br />LATHROP, CA. 95331-5108 <br />LAMA PRUETT (209)-982-2424 <br />7. ADMINISTERED BY CODE DDRW-ADM <br />� <br />See Black 6 <br />B.DELIVERY FOB <br />EX] DEST ) <br />I ] OTHER <br />(see schedule <br />if other) <br />9. CONTRACTOR CODE 00015053 FACILITY CODE <br />10.DELIVER TO FOB POINT BY <br />11.MARK IF BUS. IS <br />NAME AND <br />DMALL <br />A DRESS INTEGRITY TANK TESTING <br />SYSTEMS INC <br />166 FRANK WEST CIRCLE <br />09/30/91 <br />IX] SMALL <br />C ] VANTAGDTSAD- <br />VAt�TA:�E,.! <br />I ] WOMEN -OWNED <br />12 . DISCOUNT TERP9� <br />0 % 0 Net 300 <br />STOCKTON, CA 95206- <br />13. MAIL INVOICES TO <br />SEE BLK 15 <br />14. SHIP TO CODE ENVI <br />DLA, DDRW, SHARPE SITE <br />ENVIROMENTAL OFFICE, BLDG S-4 <br />LATHROP, CA 95331 <br />DLA0059IM9136 <br />15. PAYMENT WILL BE MADE BY CODE SDSSARFA <br />DLA FINANCE CENTER <br />ATTN9 DFC-AETWA <br />P.O. BOX 182317 <br />COLUMBUS OH. 43218-2317 <br />MARK ALL PACKAGES <br />AND PAPERS WITH <br />CONTRACT OR <br />ORDER NUMBER <br />16. <br />DELIVERY <br />This delivery order is issued on another Government agency or in accordance with and subject <br />to terms and conditions of above numbered contract. <br />PURCHASE <br />X Reference your WRITTEN QUOTE furnish the following on terms specified herein. <br />ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN <br />OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME. <br />NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE - DATE SIGNED <br />X If this box is marked, supplier must sign Acceptance and return the following number of copies: 1 <br />17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE <br />9719100.5132 01 P900.25 533181 <br />18. ITEM NO. <br />19. SCHEDULE OF SUPPLIES/SERVICE 20.QUANTITY <br />21. <br />22, UNIT FRICE <br />23. AI;UNT <br />ORDERED/ <br />UNIT <br />ACCEPTED* <br />JOB SERVICE - NON PERSONAL <br />CONTRACTOR SHALL PERFORM WORK AT <br />DLA-DDRW-SHARPE SITE, RESERVE CENTER, <br />BLDG. 75, LATHROP, CA 95331. <br />CONTRACT PERIOD: 01 JUN 41 - 30 SEP 91 <br />-Y/!t-Ori S <br />e0Z ;; l/ � Aar, �oc f j� <br />02 <br />*If quantity accepted by the Government <br />is same as quantity ordered, indicate <br />by x. If different, enter actual(�( <br />quantity accepted below quantity <br />24. UNI T ES E' CA <br />6 �� l <br />25. TOTAL <br />800.f�0 <br />29. <br />DIFFERENC€S <br />_.. <br />ordered and encircle. <br />BY: C. ROBERT ARNOLD CONTRACTING/OU;+R44- Fria -P <br />26. QUANTITY IN COLUMN 20 HAS BEEN <br />27. SHIP. NO. <br />28. D.O. VOUCHER NO. <br />310 <br />INITIALS <br />I ]INSPECTED I ]RECEIVED I ]ACCEPTED AND CONFORMS TO THE <br />I ] PARTIAL <br />CONTRACT EXCEPT AS NOTED <br />32. PAID BY <br />33. AMT VERIFIED CORRECT FOR <br />I ] FINAL <br />DATE SIGNATURE OF AUTHORIZED GOVERNMENT REP. <br />31. PAYMENT <br />-� <br />34. CHECK NUMBER <br />I ] COMPLETE <br />I ] PARTIAL <br />36.I certify this account is correct and proper for payment <br />35. BILL OF LACING NO. <br />I ] FINAL <br />DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER <br />i7. REC!_D AT t38. RECEIVED BY 39.DATE RECD <br />2. <br />40. TOTAL+CONT. <br />41.'S/R ACCOUNT NUMBER <br />42, S/R VOU-CHER NO. <br />