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Republic of the Philippines Republic of the Philippines

PROVINCE OF CAGAYAN PROVINCE OF CAGAYAN


Tuguegarao City Tuguegarao City

OFFICE OF THE PROVINCIAL ADMINISTRATOR OFFICE OF THE PROVINCIAL ADMINISTRATOR

GAS SLIP GAS SLIP

Control No.:_______________ Date:_______________ Control No.:_______________ Date:_______________

Service Station: PETROMAR TRADE Service Station: PETROMAR TRADE


Address: BONIFACIO ST., TUGUEGARAO CITY Address: BONIFACIO ST., TUGUEGARAO CITY

Please issue the following item(s): Please issue the following item(s):

Description Qty Unit Description Qty Unit

Special Gasoline Special Gasoline

Regular Gasoline Regular Gasoline

Diesel Gasoline Diesel Gasoline

Oil and Other Lubricants Oil and Other Lubricants

Signature over printed name of the driver Signature over printed name of the driver

Plate No. Plate No.

Approved: Approved:

EDNA T. JUNIO EDNA T. JUNIO


Provincial Administrtor Provincial Administrtor

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