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DESTINA 0062 5 <br />CUSTOMER'S ORDER NO. <br />NO. <br />REMARKS <br />eve_ <br />EQU7,T./ ell <br />lcwo, <br />f� � <br />DELIVERY: DATE: /loll <br />TIME: ��/ — <br />7 -Z-;:, 1 i <br />r <br />/1, <br />o" g5 <br />TOTAL DUE <br />UNLEADED GAS <br />(( <br />6 60 <br />l <br />, <br />J 0i75Z 9 <br />76 <br />UNLEADED PLUS GAS <br />J <br />PREMIUM UNLEADED GAS <br />DIESEL <br />TANK CAPS OK YES ❑ NO 1—i <br />TANK TAGS OK <br />YES ❑ NO ❑ <br />FLAPPER VALVE OK YES ❑ NO ❑ <br />END MILEAGE <br />RECEIVED IN _ <br />LOADING <br />/ <br />i :f <br />III <br />UNLOADING I�START <br />��/:' <br />MILEAGECONDITION <br />4(jp=D <br />B <br />DRIVER <br />%✓'- ' <br />DRIVER <br />TOTAL MILEAGE <br />CUSTOMER <br />