PDO-039-0

GENERAL FORM NO. 64 ( A )

( Revised July, 1974 )

REPORT OF WASTE MATERIALS

Municipality of Vintar __________ Ilocos Norte___________

State Place of Storage Bureau, City, Province of Municipality
____________
Date
Record of Sale
Item
Quantity Unit Description Official Receipt
No. Amount
Number
BULLDOZER
1 2 Pails Oil #10
ROAD GRADER
2 2 Pails Oil #10
3 2 Pcs 3SM Battery
4 4 Pcs Battery Clamp
5 1 Pc Oil Filter
FLATBED
6 2 Pcs 6 SM Battery
7 3 Pcs Elec. Wire #14
8 2 Pcs Elec. Tape
9 2 Pcs Toggle Switch
10 1 Pc WD 40
11 2 Ltrs Oil #40
12 4 Ltrs Engine Oil
13 1 Ltr Brake Fluid
14 10 Pcs Fuse
PAYLOADER WA250
15 2 Pcs Tire Interior 20.5 5R 25
16 2 Pcs Flap 20.5
17 2 Pcs Fuel Filter
DT GARBAGE
18 1 Pc Fuel Filter
19 1 Pc HHS 2000 (Oil #40)
20 4 Pcs Head/Rear Light Bulb
21 1 Set Tie Rod End
22 1 Box Rubber Cap
23 1 Ltr Brake Fluid
24 1 Pc Clutch Lining
DT BLUE
25 2 Pcs Master Kit
26 1 Ltr Brake Fluid
BACKHOE
27 1 Pail Oil #10
XXX
Certified Correct; Disposal Approved;

ROGELIO AGSUNOD HON. LARISA C. FORONDA

Property Officer Municipal Mayor

CERTIFICATION OF INSPECTION

I HEREBY CERTIFY that this property enumerated above was disposed of as follows:

Items __________ Destroyed/ For disposal

Items __________ Sold at public auction
Items __________ Sold at private sale
Items __________ Transferred w/o cost to
Items __________ Continued in service
Items __________ Kept in stock

Property Inspector: Witness to:

ENGR. CHRISTOPHER V. FLORES GERONIMO T. FRANCISCO, Jr.

Engr. I, Motorpool Supervisor Mechanic 1

SECOND ENDORSEMENT

Respectfully returned to the __________________________________________ hereby approving the action of the

property inspector as continued in his foregoing certificate. The proceeds from the sale should be taken up as credit to
_______________________________________________.