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I MHA - MODESTO PURCOASE <br />MHA- LOS BANOS a Cost Center Number f "� <br />SUTTER - TRACY REQUEST FOR EQUIPMENT OR SUPPLIES WHICH ARE NOT AVAILABLE FROM GENERAL STORES. <br />COLUMNS 1-8 MUST BE COMPLETE PRIOR TO FORWARDING TO MATERIALS MANAGEMENT. <br />8 RETAIN THIRD COPY FOR YOUR RECORDS <br />RIGINATOR T DATE VICE PRESIDENT DATE <br />:)ST CENTER MGR. DATE d SR. V.P. DATE <br />HECTOR <br />DATE SR. V.P. FINANCE <br />RECTOR/SUPPORT SVCS. DATE PRESIDENT/C.E.O. <br />IS THIS PRODUCT NEW TO DEPT.? ❑ YES ❑ NO <br />IS THIS A HAZARDOUS MATERIAL? ❑ YES ❑ NO <br />IS MSDS FOR THIS PRODUCT ON FILE IN MHA'S MASTER <br />MSDS BOOK AND YOUR DEPT. MSDS FILE? Cl YES ❑ NO <br />IFICATION <br />DATE <br />DATE <br />FOR CAPITAL EQUIP. USE ONLY <br />❑ Budgeted Cap Item # <br />Cl Non Budgeted Cap Item Sub # <br />Amt Budgeted Approved By <br />Is <br />C <br />COMP <br />RED. <br />E A <br />DATE <br />QUANT. <br />PRODUCT <br />MFG.OR <br />POSSIBLE <br />P E <br />E G <br />DESCRIPTION <br />EST. <br />P.O. <br />NUMBER <br />VENDOR <br />O <br />COST <br />S R <br />E Y <br />77 <br />Iu <br />z <br />J <br />Z <br />t- <br />t - <br />H <br />4 <br />4 <br />W <br />a - <br />Q <br />3 <br />F- <br />O <br />z <br />0O <br />W <br />z <br />J <br />f!f <br />Z <br />H <br />to <br />a <br />w <br />O <br />z <br />0 <br />G <br />RIGINATOR T DATE VICE PRESIDENT DATE <br />:)ST CENTER MGR. DATE d SR. V.P. DATE <br />HECTOR <br />DATE SR. V.P. FINANCE <br />RECTOR/SUPPORT SVCS. DATE PRESIDENT/C.E.O. <br />IS THIS PRODUCT NEW TO DEPT.? ❑ YES ❑ NO <br />IS THIS A HAZARDOUS MATERIAL? ❑ YES ❑ NO <br />IS MSDS FOR THIS PRODUCT ON FILE IN MHA'S MASTER <br />MSDS BOOK AND YOUR DEPT. MSDS FILE? Cl YES ❑ NO <br />IFICATION <br />DATE <br />DATE <br />FOR CAPITAL EQUIP. USE ONLY <br />❑ Budgeted Cap Item # <br />Cl Non Budgeted Cap Item Sub # <br />Amt Budgeted Approved By <br />Is <br />