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Pf <br />DATE: <br />- . <br />DESTINATION tDE <br />, , <br />/ (l v L � 1''� r <br />l <br />DELIVERY: <br />TIME:C�� - <br />CUSTOMER'S ORDER NO. <br />EQUIP r r <br />�N j I <br />REMARKS <br />TOTAL DUE <br />-•COMMODITY• <br />1 <br />W7 <br />• <br />COMMODITY <br />-. <br />• <br />.- <br />7UNLEADED <br />UNLEADED GAS;%9. <br />PLUS GAS <br />PREMIUM UNLEADED GAS <br />DIESEL <br />TANK CAPS OK YES ❑ NO ) TANK TAGS OK YES ❑ NO ❑ FLAPPER VALVE OK YES ❑ NO O <br />r END MILEAGE <br />RECEIVED IN GOOD -" LOADING j ' UNLOADING START MILEAGE <br />CONDITION BY DRIVERJDRIVER !•!% r 'i %/ TOTAL MILEAGE <br />CUSTOMER <br />