Laserfiche WebLink
U.B.GOVERNMENT <br /> PURCHASE ORDER—INVOIC._ .VOUCHER <br /> DATE OF ORDER <br /> ORDER W. - - <br /> 1/16/ o "P9222 <br /> NUXT NAME AND ADDRESS OF'-..!,—eo Uyasse.$d.C ms s)t <br /> Is PUBLIC HEALTH SERVICES, SAN JOAQUIN COUNTY <br /> i 1601 E. HAZELTON, P.O. BOX 2009 <br /> E STOCKTON CA 201 <br /> FURNISH SUPPLIES OR SERVICES To(Vaaw wW jd AU)t <br /> SACRAMETTO AFS <br /> 9624 KIEFER BOULEVARD <br /> SACRAMENTO CA 82 - 882 <br /> SUPPLIES ON SERVICES QUANTITY UNIT PRICE AMOUNT <br /> UNDERGROUND STORAGE TANK <br /> FEE FOR STOCKTON FACILITY <br /> 2 0.00 <br /> I <br /> i <br /> AGENCY NAME AND BILLING ADDRESS t <br /> P <br /> Federal Aviation Adminisfraf)on TOTAL 2 0,00 <br /> A P.O.Paz 92007,%V,,Idway Postal Center,.AWP-446 DISCOUNT TERMS <br /> BY ---% -----MY9 <br /> Los Angeles,CA 90009 DATE INVOICE RECEIVED <br /> ORDERED BY(S/Imfarr ad UDI) l.t_..1.:... <br /> __MICHELLE C01 K IMS SAC AFC Y <br /> PURPOSE AND ACCQUNTING DATA <br /> 382.0/48064/330-90419/2391 <br /> UST permit for SCK <br /> PURCHASER—lo sig low Iw_ er-the-c voter delivery of items <br /> RECEIV[Qgy JACOBS <br /> TITLE <br /> TA 6/90 <br /> SE LER ! c read InStructiOnS on Copy 2 <br /> ❑ PAYMENT t PAYMENT B' <br /> RECEIVED S_____________________ REQUESTED SNO FURTHER INVOICE NED BE SUBMITTED <br /> SELLER <br /> DATE <br /> BY <br /> - (SlrneMe)• <br /> INSTRUCTIONS TO SELLER <br /> After satisfactory identification of the Government representative➢resenting this <br /> Durchese order, verify the itemisation, Including Quantity, unit D+Ice, amount, <br /> total and discount sections. <br /> This form is so designed that Copy I may be used as a cash payment receipt or <br /> as your invoice by completing, as appropriate, either the Payment Received or <br /> Payment Request blocks and signing the Seller Section. <br /> If you would rather submit your own invoice,DO NOT SIGN COPY 1,but attach <br /> It unsigned W your invoice to expedite verification and <br /> DroceaeinB for Payment <br /> 2.SELLER'S COPY OF ORDER STANDARD FORM Nb(Ha,..10-53) <br /> PRESCRIBED BY GSA, <br /> FAP"e CFR)532/3(0) <br />