asg form ; purchasf‘ asg^.- form 672 (rev. 7(71) ^ tsfieour^a /purchase reqrsition american...
TRANSCRIPT
ASGFORM ■;
..,672 |REV. R/87),PURCHASF
L 4. ORIGINATOR S NAME 4 TELEPHONE NUMBER - • 5. DELIVER TO. ''l'' " : 1 i'' 6. OATE WANTED SFUND RECORDS CTR ■
M.A. LKLAUYI ‘‘ •\.t SHinoims & Receiving ■ -"V \ ' Askp 5103-00006 !
757330-5994
5^tef!t1,, .• ,j-/-,>■■■
to3 * ■ -i -C
SJICAN SAMOA GOVERNMENTF VAGO. AMERICAN SAMOA 9679S . . .
^ .'■VI'' 'V.’ * • , - ■ ' ’. ' V- __
3. rODAYSDArt,.-,.;. .Jr,-. *•■!> >• V, •.s. ■<;.*]>■ •; --41 •*,■< ;p1442 *'
DAVID K^:LIHDEHDTH CO. LTD. .
BR1SBME, CALIF. 94005 ' '
*'v. V.
REQUISITION NUMBER' |
09861 !
□ SURFACE,.:
□ AIR FREIGHT
□ SURFACE MAIL
: Q-airmail'.
□ OTHER
SFUND RECORDS CTR
88224741
IF AIR SHIPMENT GIVE.JUSTIFICATION
« PART No. AND/OR DESCRIPTIONMOOEL No. A SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDEREO
QUANTITY OESIRED -
ESTIMATED UNIT PRICE (IF KNOWN)
TOTAL ESTIMATED PRICE (IF KNOWN)
9. FOR PROCUREMENT ONLY
1. GAS, CHLORTNE, Comaetiial grade,low pre
ssure liquefied. 150 pound capacity perl
cylinder. For: chlorinating water supply
system.■ (REFTI.I.AKI.R CYLIHDER) vV
: . '-V'-1' \ . .'V./’'i£-TcLT V'.~ ■ . ■■ .
"M0IE::EMPTIES CYLINDERS SHIPPED ABOARD POLYNESIA V-1Q4NB UNDER B/8
#PLL021999 DTD 8/21/92. EMPTIES ARE TO BE REFILLED & RETURNED TO ASG.?
75-cys. 78.40 $5,880. K)
ESTIMATED SHIPPING CHARGESi. ,
I„200000■ C,.',Cv'/v -?f"
■ •/' .' ‘. s • “1'' ;
TOTAL REQUEST
$7^080,00
SCREENING AND APPROVAL SIGNATURES ''
11. DEPT. APPROVAL $1,000-$10.000 '. - - •,/ ■■ ■■ v ' ' ' •
PAUL FELI5E
Chie#_pgocttreBe?fe^|(|l^orL
12. PROCUREMENT SCREENING
• PROCUREMENT OFFICE USE ONLY
.15. PROCUREMENT REVIEW COMM. ,t.<? 16. Ap’ORNEY GENERAL... .17: PURCHASE OROER No. ..
v-: • ,r•18. PURCHASE ORDER ISSUED'.
1S. SHIPPING INFORMATION
u , j INSTRUCTIONS'i.- 'COMPLETE BLOCKS i THROUGH 7 AS"INDICATED?-'"’ 4 ~' V ‘ ?-WVc.:r; ' V?’ . V-"'
2. . CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8.1 ALWAYS,GIVE,PART;NUMBER AND/OF?; BRIEF DESCRIPTION Of= ITEM. BE SURE TO GIVE QUANTITY DESIRED AND
' - ESflMATEiTUNlTAND/fOTAL^PRICE IF,KNOWN SHOW ESTIMATED SHIPPING CHARGES. •
• ' DEPARTMENT FILE ... ' „
T"0*
u ASG-r x ^--’FORM.y
r\7%>~-1krr
PURCHASE RET / V#* >$4*AMERIC %AMOA GOVERNMENT
1. ACCOUNT No. v.' 2. DEPARTMENT -7530-5994','\.i%,' Office' of;
. . . 3. TODAY'S DATE f *
Procurraien ; January 16, ,1980 ,rREQUISITION w :•NUMBER ■*. UU0 4b
v jh- t -w £*: ■ • ' •„ ' '4 ORIGINATOR'S NAME & TELEPHONE NUMBER ) ; '.M-?,*.,.' ■ M.^Toleafda>*’ - ‘ 5 DELIVERTO ' • '. iy - ' '• ‘j
Shipping & Receiving yy' '”-i.:6:datjWanted.--‘ , , , , ,
ASAP " 7,
■ -.7..SUGGESTED VENDOR ... • > . '' >■ f? \ : f, , ’.. ■ t--. y" y < :<'<■.<;< y' ■
David K. Lindemuth Co., Inc.
-^1681 Grandview Drive
South San Francisco, M. 94080
* '»■ 1 ...... •, ", k V,- . A- ' ■ •. ■; ", Vr. *7
.* _ •*■>' u /y-V! " . v •• :'7; y. y.'s J: ■ /V/;
reouested'method of shipment f 1 ' ,.□SURF^CE^yrilvV^'^ / ‘r ■
, □ AIR FREIGHT y' ‘ '
>□ SURFACE-MAIL 7 ’ - '* y ',
, □ AIRMAIL ........... .
..□ OTHER ,l ”•
IF AIR SHIPMENT.GIVE JUSTIFICATION. . ■' • .'’ "Z t'- ■ • '.a*.*? fr
.• »y:'- y.y-: . i'jrf J’/f y ■ T - l, :
•V - 1
item'
No.
' . * ■ y1-' ’ PART No. AND/OR DESCRIPTION ’
MODEL No. S.SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDEREDQUANTITYDESIRED
ESTIMATED’
< UNIT PRICE - . (IF KNOWN) ’ ’
TOTAL;ESTl- »• MATED PRICE (IF KNOWN)
9TOR PROCUREMENT ONLY 1 • -
PRICE ' . \-. " - TOTAL
Empty Chlorine, Gas,N for refill and ' / .*r '' j- ■ \ -r-.jv;
return to American Samoa Government. 30-cy. $78.40, $2,352.( <
Chlorine Serial No’s; Listed.vy <
‘ ’ . ..a;
■> frif >/r;‘\ v.-fe-’ '
C‘ *• ■■- !. ,*V -. 'v. • •
■<£r.v-
1. 811124 : 16. 10802 y -</ . -. - ; V2. ,16543 17. 419997 ••.. *'
; r:wv v1-
-419977 f / 18. 6068327 L . ~ .y ' . / / ;J f:
4. 16555 ■‘-vC' 19. 6068298 • ’ < r •' t y? 7! T. y. ..
«O03®O898 20. 6110962 . •’ : . i;-1 v I-. ....) . ■ ■
21. 4199667. 4120007 22. 419963 ■■■8. 6068328 23. 419982 :9 . 3114 419970 , - > - •■<-?■< i >-y^' '> •'
’'I* '■ ’ , ■ ■'10. '1368 25. 419976: /" ■T*T' ■7^-.. .
■-T ' 11. 811136 26. 811117 ; -V. , %-',v
■ ■ 'y. 12i <811153 27. 811805^13. 811141 28. 811146 v .v
a.. . V ’. •; ' -T
14. 811100 29. 811145 >.-yr ; : y 7
15.: ,811119'S •• .*" 5. is. • ’ >*SV - *
• ; 30. 811125 t. , ' _;'• T'l';
, y/jW'
;■ ,<•<•:
* V; v ; ’-V..;- ‘J* ESTIMATED.SHIPPING CHARGES $ 588.0( ) A
r, •*•;•*•*••* -} :< /.v -Tv yy
; • • ;4.'TOTAL REQUEST $ 2,330.O(
. ' **.
• --j .•
>. .^ •; •
SCREENING AND APPROVAL SIGNATURES
10. DIVISION APPROVAL 0*1.000 -?“■ i.A.'LELAUTI -
Manager, Property & Supply
11. DEPT. APPROVAL $1,000-$10.000 ' *;• 'i;.'5.'"' ' ^£3*; PAUL FELISE
Chief Procurement Officer
12.' PROCUREMENT. SCREENING.
13. BUDGET APPROVAL^* l -■
V/. '* .> . f
14. GOVERNOR APPROVAL' v‘'"‘<,
f vr PROCUREMENT OFFICE USE ONLY
.15. PROCUREMENT REVIEW COMM.
\.r •' -2
16. ATTORNEY GENERAL. >,>. .'7 V. •” 18. PURCHASE ORDER ISSUED
19. SHIPPING INFORMATION
.VXr . 4% v INSTRUCTIONS
1 .COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. ' * • " *• ”2 ’ CHECK REQUESTED METHOD OF.iSHIPMENT IN BLOCK 8.;" X'\ S r* -'-C'-. ' '* *<, , V '£ ,‘\
\ 3 ALWAYS GIVE PART N UM BER.AND/OR :BRIEFiDESCRIPTION OF ITEM.;:BE SURE TO GIVE QUANTITY DESIRED..AND\: ■■'ESTIMATED UNIT AND TOTAL PRICE'IF KNOWN'SHOW ESTl'KilAtED SHIPPING CHARGES ’’ '
ts‘V • .-y^l . , y DEPAI?TMENTjFILE _ '• , ,
rj .
'??«/■ '- PlIRnH'A^F RT‘'•'•II^ITinN AMFRir QAMDA rtfU/FPNMPNT
FORM ...H?;;.-^672|REV. 9/87) :-f
%£ ,<v< account No ‘
'fev;
PURCHASER'- "JISITION,/Vt. ..it* ‘ •'’"IV i
AMERN SAMOA GOVERNMENT
S; PAGO PAG^ .cRICAN SAMOA 98799
7530-5994
2. DEPARTMENT*• °;i ‘ r 'it
3.T00AVS DATE;' .;..jj:
Office o£fProcuressat i September 8, 1REOUISITlON-
)89BER-,‘'00302
low
,".3*1* r- v.v.4. ORIGINATOR'S NAME & TELEPHONE NUMBER .
M.A.LelautiS.OELIVEflTO
Shipping & Receiving, Tafuna.6. OATE WANTED' , . -
v'C. ASAP'7. SUGGESTED VENDOR •
David K;, I^ndeamth^Gd^xinctfC1681 Grandview DriveSouth San.Francisco, CA . 94080
S..REQUESTED METHOD OF SHIPMENT
.'□SURFACE;;:- ,
□ AIRFREIGHT- i ,f ■* » > -•)' rt Lt- "• u-*[ *□ SURFACE MAIL , IT;
■m.v'A
□ AIRMAIL . .. J "V1H;-.,
□ OTHER -
IE AIR SHIPMENT.GIVE tlUSTIFICATiONi.'
IT.&N
W-:
ITEM ,.N *■' -• PART No. AND/OR DESCRIPTION ' •" ■ t ' . - QUANTITY ’ ESTIMATED- }' UNIT PRICE ;
‘(IF KNOWN) .-,
TOTAL ESTI- 9. FOR PROCUREMENT ONLY
MODEL No. & SERIAL No OF ITEM FOR WHICH PARTS ARE OROERED DESIRED, r, (IF KNOWN)'PRICE / •' ' .• TOTAL -
tEmpty Chlorine,Gas» for refillaand return
■; . ."■'T ' ’ '■ -
‘M' to American Samoa Government. 30 cy. ;,'v;$75v40 *2,35? 00 , . i.
1, Chlorine Serial Noei Listed ■ ~ ; “ _ ■ - ,. !_■ V . 4.’-'^ **- 4- i;.V ■■■•'...
1. 811096 15. 8110963 . i t.',; '
2. 811121 17. 6110952
l8i 10780;>’1-- •
3. 811113•' /; . -i '"' ••tr t •
4. 811192 19. 6110949 ‘ * „ r’ • :v.- -■ ;X-.
5. 811155 20.420000V‘>.f «
6. 811116 21. 6110935 T, '"V'D'v'i”7. 811114 22. 41127; . ■* ' -3'^ . .-i. • ■ " • " •'8. 811156 ' 23 V 603334 j -
: ■ '• • ^ . 8. 81113i :l.'l 24. 2876 ■, I’; .44- '>■' •' ■ ■ ‘
110.811127 25. 419964 t’ V... ..VVrV : r, ■
11. 811139 26. 811097 i' • 4 ''- -V'; '444'V -X . ~’ ■.
12. 811129 27. 811101 ; 4 " .13. 811137 28. 811151 /
14. 811115 29. 8164 .: : '■ ■ T. •
15. 811139 30. 6110932- -F.:
*" • -- ; .iVi-VrViiv.
■ >?-N: . - •; '.'V *•. ' • .... ESTIMATED SHJP_PING CHARGES I88S( 00 ’V.....‘
'.'i: i i R EQUES.T,; $2,940,
>-o
SCREENING AN^/ApROVAL,SIGNATURESV": ii:'.' ■ ‘ -‘-y ' • -• . ■ . ... _
IIS’
1% v; •
v• ■' -
IflPBtvrS^ON APR»eVAL oyrooo .v
4 vM.A. LELAUTI ;
11. DEPT. AP/
CHIEF PEjOCUREMEHT OFFIBBR;
12. PROCUREMENT SCREENING
13. BUDGET APPROVAL 14. GOVERNOR APPROVAL
PROCUREMENT OFFICE USE ONLY* / p
15 PROCUREMENT REVIEW COMM.-
- v . '.,v’ A,'
16L‘ ATTORNEY. GENERAL.: 17.-PURCHASE ORDER No v- 18. PURCHASE.ORDER ISSUED
Vv.r
19. SHIPPING INFORMATION 20. VENDOR
.V /VI
INSTRUCTIONS1. COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. . ' ' . . "" .2. CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8. ■ /i " .3: ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF;ITEM, BE SURE TO GIVE QUANTITY DESIRED AND V i
ESTIMATED UNlf AND TOTAL PRICE IF KNOWN SHOW EStlMATED SHIPPING CHARGES. ’. ...........; V' r: “ " .;-.11
■ DEPARTMENT FILE.'. T
MM
“>y\
J&U.. ' *. PURCHASE REQUISITIONMUSI'S /■>-- •' •■
/".-I ACCOUNT :-'..Vt5»'-vy- ■';' W.\\, 2 PEPA^TMENT > •■ .<''jfcl'(;&;v '-aft^S .3. TODAY'S date , ^ , ■•;
' X"- .' ,^' 7*5
7S3<M994 Office of grucureraeit May 15, 1989
AMEfl{C \N SAMOA GOVERNMENT
,-• ■-•PAGOPr 'jMERICAN SAMOA 96799 , ..
REQUISITION'NUMBER. '.’•;
00363
,£;i.'SV>■SsS®
•gS?
4! ORIGINATOR'S NAME » TELEPHONE NUMBER 'H. A.:‘;Leiautii*; .,£ •&;»*
5?oEL(yERTo^.»i.;/-.i|yv^:;'.i/',...’■’tfV'f /
'Shipping ^ Receiving, Tafuna6. DATE WANTED
ASAP". 7: SUGGESTED VENDORS
sSSkv&V;/ca? ,H ■{.A7?:yr-J- ■
ft- T*k-
*'DavidsK.LlndeiaathCo.^Incrf681»6raBdvdtew>Dfive^’'-''-'':^i''i "> .'‘■'n'veWSouthSaa Francisco, Ca. 94080
S^REQUESTED METHOD OF SHIPMENT* ‘';r ’’ ' • “
•□SURFACE ' , • ‘ ■
- ■' jiv •
□ SURFACE MAIL •• .
v □ airmail. LV.r V-.l1 :'/VjV ' ’ t. s-
□ OTHER o.■;
‘jF AIR SHIPMENT GIVE JUSTIFICATION •> . *' l' t’
ITEM PART No. AND/OR.DESCRIPTION * ' QUANTITYESTIMATED ' TOTAL ESTI- 9. FOR PROCUREMENT ONLY
MODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE.ORDERED. ^ DESIRED • {IF KNOWN) ' . {IF KNOWN) PRICE TOTAL
1. Empty Chlorine Gas , for refill and return Y
„,to American Samoa Government. 45-cy. $78.40: 13,528.0 0 ■
Chlorine Serial No *s; Listed. > -i’’* l; V
-■'M- 1. 6110919 18. 16520 35. 419992 .';L::r:--\ •*
2w .6554* '*;■ .4" 19. 6110938 36. 419984v.
3. ' 419978 20.. 10817 • ,37. 6110927 ■’t ? - . 1 r"'-- .--r• * -
4. 6110951- : 21., 5806 38. 419975• ■>:
\ ■i' ; - •' . '• .
" .~T'5. 10784-: 22.. 3207 39. 16559 "
. ■*/.**.•■ '■: •/
. . . ■■
6. 420009.' v23.. r 10788 40. 6068333 _K.. '
, .7. 418998 24. ' 16541 ; 41. 6110946 L'V"
8. 16549;: 25'^ 6068322 42., 2159 vr".;. r . ■ "V- ■- ■ ’ .
9. 6110918 26. 3226 43. • 2324 J
’ s 10. 6068306 27 i 419990 44. * 6068304 ,V- ■■ ;; “ >r’-.s 1 >' .
.. " .• '.L
-: ■ 11. 419973 28. 16519 - 45. •/. 16552 '
12. 16521 ■*> 29. 16528 1-1 ■ Vi-V"'J * -■*V •• ' \u-. r ;
13. 419989 30. 16553 .' ■ * •
14. 419994 r 31., 6068302' - . . s— •
. .•, ■- .. ■L' , w • • .
15. 6068307 32. 6068335
16. , 10813 . 33. 419987• ’ • .\.V. v
17./ 16551 ^ 34. •- 16536■V • ■'
1' : ' ’ - J*'; ’ ■v,‘ '
•’ —> .• ..
>.•ESTJMATED SHIPPING CHARGES $882.00
j ’ . __ .• ..." /iJf
tJ ;T vCi > .■. ■
TOTAL REQUEST ; 4,410.0 3 ;t
■ ‘.-V- .<■'
SCREENING AND APPROVAL SIGNATURES
10. DIVISION APPROVAL 0*$1,000"
M.A. LELAUTI
11. DEPT. APPROVAL $1.000:$10,000',
PAUL FELISE Chief Procurement Officer
12. PROCUREMENT SCREENING
13. BUDGET APPROVAL 14. GOVERNOR APPROVAL
V '£ » <1 *>
PROCUREMENT OFFICE USE ONLY ..
15. PROCUREMENT REVIEW COMM.- -: 16. ATTORNEY GENERAL .7 17: PURCHASE ORDER No:':" ttt.PURCHASE ORDER ISSUED'^
19. SHIPPING INFORMATION
4 *
V_ p fte
INSTRUCTIONS1. COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. /: V ................................
2. CHECK REQUESTED METHOD OF SHIPMENT.IN BLOCK 8.;,. J '-
3. ALWAYS GIVE PART NUMBER AND/OR BRIEF,DESCRIPTION.OFilTEM. BE SURE TO GIVE QUANTITY DESIRED ANDuV ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES. ■. " '
DEPARTMENT) FILE
‘ ASG^.- FORM672 (REV. 7(71)
^□TSfiEour^a
/PURCHASE REQrSITION AMERICAN SA' ^A GOVERNMENTPAGO PAGO, A^, .N SAMOA, 96799
2- DEPARTMENT 3. TODAY’S DATE
7530-5994 )ffjce of Procurement November 19, 1987. 4. ORIGINATOR'S NAME & TELEPHONE NUMBER
M. Toleafoa
5. DELIVER TO
Shipping § Receiving
REQUISITIONNUMBER 53391
6. DATE WANTED •/-□ ■ ’
7. SUGGESTED VENDOR
-;■ David K.;-Lindemuth Co.; Inc., „• 1^81 Grandview ’-Drive - South San Francisco, Ca. 94080
-c- >
8 REQUESTED METHOD OF SHIPMENT
□ SURFACE , '
^□/AIR FREIGHT - _ /□:?SURFACE MAIL ’
.□airmail, ; ■
□ OTHlRif A[R SHIPMENT GIVE JUSTIFICATION
‘ ,:y.r;■* /?" Tf-V. •_ ^ ,V.v J-
ITEMNo.
1.
*v •, k'VPART.No. AND/OR DESCRIPTION ■ ' 'V'MODEL No.'& SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED
Gas, CHlorine for refill and return to American Samoa Government... ..... ►
Chlorine Serial No*s; Listed.
1. 6170938 11. .1784 k21.y::' -16523
2., 2324 12. 10783 : 22. .6068329
3. 16519 13. 6110928 23. 31144. 16928 • 14. 3116 / 24. 16558 V
5. 3200 15. 10809 V 25. 6068300
6. 6068325 " 16. 10819 26. 16530 v
7. 16545 17. “■ 6110949 27. 419970
8. 1368 /-a"* 6068319 28., 6068299
9. "6110963 •19. 6068326 29. 10821
10. 6110935 !> 20, 6110950 30. 16521
• Cu; ,122*Wt: 2400-lbs.?
QUANTITY • ■ ‘ DESIRED
30-cy. $78.40.§
-.^ESTIMATED . ■ 'UNIT PRICE
(IF KNOWN)'
^ESTIMATED SHIPPING CHARGES ,
7 TOTAL REQUEST
TOTAL ESTI- ' MATED PRICE {IF KNOWN)
$2,352. 00
1588.00
$2,940.( 0
9. FOR PROCUREMENT ONLY
SCREENING AND APPROVAL SIGNATURES •
10. DIVISION APPROVAL 0-S1.000 11 .' DEPT.‘APPROVAL $1,000-510,000 . „ , L,
L.M. SEUI i leting,;Chief Procurement Offic»
13. BUDGET APPROVAL
12.' PROCUREMENT.SCREENING
14. GOVERNOR APPROVAL v
•PROCUREMENT OFFICE USE ONLY
. 15.-BIDDING DATE-MAILED 16. DATE BID AWARDED '
19. SHIPPING INFORMATION
17,‘PURCHASE ORDER No. 18. PURCHASE ORDER ISSUED
JINSTRUCTIONS
. 1 COMPLETE BLOCKS I THROUGH'Z’AS INDICATED ' , - ' V '-.’V ” - '**2 CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8
• 3 - ALWAYS GIVEJPART.NUMBER AND/OR.BRIEF DESCRIPTION;OFvlTEM:®E SURE TO GIVE QUANTITY,DESIRED.AND %'^s ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW-ESTIMATED SHIPPING-CHARGES.
DEPARTMENT FILE
;:sv: -•/. v-;-4
ASG
Rl\
REV. 9/87)PURCHASE REf ISITION AMERICAN—'10A GOVERNMENT
PAGO PAGO, \ JOAN SAMOA, 96799
1. ACCOUNT No '»:.1
7530-59942. DEPARTMENT . V v
Office of Procurement3. TODAY’S DATE • - v : .
January 12, 1988.REQUISITIONS
NUMBER 700024..ORIGINATOR'S NAME & TELEPHONE NUMBER.
M. Toleafoa5. DELIVER TO
Shipping 6 Receiving6. DATE WANTED
A.S.A.P,7. SUGGESTED VENDOR
,David K. Lindemuth Co. Inc.,; 1681 Grandview Drive'South San Francisco; Ca. 194080
8. REQUESTED METHOD OF SHIPMENT .
□ SURFACE
□ AIR FREIGHT<. .
„□ SURFACE MAIL
□ AIRMAIL
□ OTHER
IF AIR SHIPMENT GIVE JUSTIFICATION
ITEM No. • V- , ■ PART No. AND/OR DESCRIPTION’^-MODEL-No.& SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED •’ " ->i" >>• ! QUANTITY../- DESIRED
.-ESTIMATED ., UNIT PRICE. -t- •.(IF,'KNOWN) •/■'U.-TOTAL ESTI-. /MATED PRICE (IF KNOWNJVv
.9, FOR PROCUREMENT ONLY ...PRICE 1 "... ■■ TOTAL ' / •'
1, Gas , Chlorine for refill and return to . . : , • - ~
£ :.F' /! '
American Samoa Government. 45-cy. $78.40 >3,52S.( 0 '. .- • •
*»• *■. V. t" :Chlorine Serial No's; Listed. 4 • .r-• --V.
• •
1. 6068322 15. 420011 89. .419999 43. a: 0010h I.**- <\ ■' * .r f
2. 6110962 16. 10784 30- 10789 -44.:7: '29 /V: < f -3. 10808 17. .419968 ,31. 6068302 45. 6( >68324 v)..4. 16532 18. 3260 32. 16550 ; -5. 6068830 19. 2237 ... 33. 819966. ..6. 6068318 20. 10814 -34. 10790 . a , ’-J ' ' /■' - "/> - -- ' *• • -V
7. 13121 , 21. .10815 35. -419972 v % fj, t '"iMk8. 6110947 ' 22. 1575 36. 806836 \ '9. 419971 “ 23. 6110953 -37. 419994
, r ...-F
10. 6110945 24. 16538 .38. 1011 -} * V
-.1 - vT--. .*. jr. . c , .
11. 16554 25. 420013 39. 611096512. 16552 26. 10806 40. 2159 : ’v13. 1827' 27. 419984 41. 611093214. 16549 28. 6068299 42. 420008 - '
' -v — / C" •'V/ £ ft', r , __ESTIMATED SHIPPING CHARGES
S882.00
,,„r, TOTAL REQUEST- $4.410.C 0
SCREENING AND APPROVAL SIGNATURES
10. DIVISION APPROVAL 041.000•-V-' ' • .,
11. DERT. APPROVAL S1.000 J10 000
BEN M. TAUChief Procurement Officer
12.-PROCUREMENT SCREENING
13. BUDGET APPROVAL 14. GOVERNOR APPROVAL
PROCUREMENT OFFICE USE ONLY .
15. PROCUREMENT REVIEW COMMITTEE 16. ATTORNEY-GENERAL 17. PURCHASE ORDER No . PURCHASE ORDER ISSUED
19. SHIPPING INFORMATION
~ „ A **>45, l t
INSTRUCTIONS .
1 COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED2 CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8 ' -3 ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF ITEM. BE SURE TO GIVE QUANTITY DESIRED AND
ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES * J , *
DEPARTMENT FILE " :
PU R C H AS E T^dOlS ITI0 N
A.AM EH’ ~a'. SAMOA GOVERNMENTpago t American samoa, 96799
2. DEPARTMENT/',. - .*«\ ;K>‘ •'
Procurement Office .
3. TODAY’S DATE'/ ,' ', .'/>/ ;
“'April 8, 1988.
Y"', „ /------ ---------------T~-------■ ... •v—:- ■
REQUISITION ' ' • ; TftftTITNUMBER m^v-y. 1 UU | 3
4. pRIGINATOR^S NAM6;4.TELEPHONE.NUM8ER.;/> / *t > /-y
:v Mi Toleafoa5. DELIVER TO ^ * ■ . ■ * ,
Shipping $. Receiving
0. DATE WANTED ” * -v
ASAP :• • ’7. SUGGESTED VENOORy
i.-V, ■ A> .!> Vt iifcV
‘"AM
South San Francisco; Ca. 94080.
\ ;4r'-I-
8. REQUESTED METHOD OF.SHIPMENT
□i SURFACE' ' K1 * 1v □ AIRFREIGHT':;;.:. -
: □ SURFACE MAlirV '* '* - . — - > ...
AIR MAIL., \:X~\ '□ OTHER ' ' ' ' ■'
IF AIR SHIPMENT GIVE JUSTIFICATION
ITEMNo.
. /*'; PART No. AND/OR DESCRIPTION "VMODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED
QUANTITY OESIRED .
ESTIMATED ’ UNIT PRICE J
’ (IF KNOWN)
TOTAL ESTIMATED PRICE (IF KNOWN)
9. FOR PROCUREMENT ONLY.
1. Gas, Chlorine for refill and return to American Sanoa Government.. . .. . a.;.
Chlorine Serial No's: Listed. ,
30-cy. $78.40
1. ■ 6068307; ; i IS; 419964 -2. 41997S . 17. :165583.; 10824 -f/ 18. 419989,4. 6068301 19. 419973
419987 V y ;20. 10788,6. 6110918-’ - 211 419992 ..7/ 6068306 v : 22. , 108178. •■16515.; 23. 60683339. ■ 108131 ;//y 24. 419978-
10. 420000 r /A?: y 25; 420006:11. 419998' '/ r 26. 16555 : . ;12. 419980 27. 2050 =13. 16534 28. 611091ft;14. 10792 29. 6110946IS. .. 16561 30*, 6110948'
52352.0(
7 W' ffi
■■ •.. 'C^‘ ,',L
•K '• ;
xMifrxCU:WT: 2550;
122-
: lbs.ft.
n^rir V ESTIMATED SHIPPING CHARGES |tgg qq
K • TOTAL REQUEST .•K. 52,940.(0
^ SCREENING AND APPROVAL SIGNATURES ►
10. DIVISION APPROVAL 0-11.000':-;V’
11. DEPT.-APPROVAL S1.000-S10.000 • •
'• : BENM.TAU
Chief Procurement Officer
12."PROCUREMENT SCREENING'.
13. BUOGET APPROVAL 14. GOVERNOR APPROVAL •
PROCUREMENT OFFICE USE ONLY
15. PROCUREMENT REVIEW COMMITTEE - 16. ATTORNEY GENERAL
1~~‘ '' j'; ->■ . ' »<- < i- V' «
17. PURCHASE ORDER No. ...-
• V at '*'-'1 r18. PURCHASE ORDER ISSUEDVi.>. ft. .-.v. . J . . r'i’
/ ' ’ ‘
19. SHIPPING INFORMATION
w‘ '-'ht
INSTRUCTIONS:"'1.' COMPLETE BLOCKS T THROUGH'7?AS INDICATED ,V- 2. CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8T ' '
, 3. ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION.OF ITEM: BE SURE TO GIVE QUANTITY DESIRED AND- t ESTIMATED UNIT AND TOTAL- PRICE IF KNOWN SHOW ESTIMATED SHIPPING"CHARGES:'^r.:-L".v‘--‘./; : i
f ■©S'
DEPARTMENT FILE
ASUFORM
,672 (REV. 7/71)PURCHASE REQUISITION
-• - '4 / ,&\V5V* I-
.1. ACCOUNT No. -
-“=-77530-5994;'2. DEPARTMENT..
General Supply. ORIGINATOR’S NAME & TELEPHONE NUMBER
^tTsuGGESTED VENDOR
3. TODAY’S DATE
’: AMERICAN SAMpA GOVERNMENTPAGO PAGO, AMEPr "N SAMOA, 96799
5. DELIVER-TO-^ UV K.Shipping &‘RBedLvi6g7- -;;v
joies 0B3#gCvTnc..
U ;Hilpitas,CA. 95035 :(403^262-8300)~
,£»., IKC. kji■ 1681^Grandview Drive
REQUISITIONNUMBER - 3 65434 A
6. DATE WANTED
8. REQUESTED METHOD OF SHIPMENT^',.).
XSX SURFACE ; A'.
□ ■ AIR FREIGHT
□ ■SURFACE.MAIL W/V ' □'AIRMAIL ■ f"i \y ‘□ -OTHER V' . ■
f. .t
IF AIR SHIPMENT GIVE JUSTIFICATION •
tiCr-T- ...
M
ITEM \ No. '.‘MODEL No
Soi^Sa^f<rdaftffiijab®To»CA.-.1.794080 . ;FMC#2274 »EL Na S SERIAL No.'OFJTEM FOR WHICH PARTS ARE ORDERED ; — .*■ “
.QUANTITY'OESIRED
-ESTIMATED ■ UNIT PRICE (IF KNOWN) •
TOTAL ESTI-. MATED PRICE. (IF KNOWN).. .
9. FOR PROCUREMENT ONLY
1. GaS. Chlorine, for refill and return to American Samoa Government.
2; -^S;'.Catbqn'.Diaad(le#' :£&,.re^i1and return to ‘
60-cy.
30-cy.
Enpty Cfalorine Serial-flip*s. listed.
1. y42006 713,2. V419982 :14.3. 419966 15.■4. 419997 /---
,3. >419989 16.6. ‘ 419961 ■; 17.
^;7,:Bl6555:ii 18.8. 10814 7719.9, 17157^20 v
10. .420010 >21.11. >419976;i22.: 12. 419994 23.
420003419984;419975
16554 I.419976r10824v420013419963.41999816550420009
;. 24.1.430011 >25. >2449 r ;26. -10788 "27. ., 419990
, 28..:. ;-419963 ..29. :10791 .30. /419993
••/, 1 ‘"VKV\ ' 4-rl „ .
. CLJ: 244* v
; Kr:>;4,800-lbs.
$76.00
$40.00.
$4,560.
-5 “ '
$1,200;
X)
Kffe
'■ r.
A-
CANT'D.'
i. ' ) ‘ :•1
ESTIMATED SHIPPING CHARGES' $11440. >0 i■t:-
V .TOTAL REQUEST $7^200.00
10. OIVISION APPROVAL 0-S1.000
* V, SCREENING AND'ttPPROVALSIGtyATURES
11. DEPT. APPROVAL J1,0ix«10t00p ..
'•/: ’’A V- Chief Procnrprraht
12. PROCUREMENT SCREENING
v
13. BUDGET APPROVAL ; . \r
V,'
14. GOVERNOR APPROVAL *
; PROCUREMEnYoFFICE USE ONLY
15. BIDDING DATE MAILED 16. DATE BID AWARDED • 17; PURCHASE ORDER fy>
Vsfc®.’. • 'c,
18. PURCHASE ORDER ISSUED
19. SHIPPING INFORMATION-20. VENDOR .
if- ' .;.si• -•* L-..'. • y r A^-v. 7T-L<^ "*
' ' < v’ rl ; " 5- -21 T ^ /t ^ t 1' . , t < * i"-'-:
.-4
T ■ INSTRUCTIONS
.1. COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED- i‘?5i ' - .7 ; ’ ,V v2 CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8 , ' « -7 - "
.* v3..vALWAYS GIVF PART-NIJMRFR ANn/DD'RDitrr ncopDiDTir»M r\r- i-rr>< _ .r. ■■,3..
0 ruLfl/ nmi ,r‘: ’1,1 "-Our r / Mo/ilNUiUA I tLt
DEPARTMENT FILE
./BE SURE JOiGIVE QUANTITY DESIRED AND -7.* > HIPfr
/ •
SEV. 9/87)PURCHASE RF^jlSITION /,-? ? AMERICA' " AMOA GOVERNMENT
PAGO PAG .ERICAN SAMOA, 96799
1. ACCOUNT No.
7530-59942. DEPARTMENT • ,
Gffiee of Procurement3. TODAY’S DATE .'
February 9, 1988REQUISITION^
DUMBER 700124. ORIGINATOR’S NAME & TELEPHONE NUMBER
M. Toleafoa5. DELIVER TO r]1
Shipping 8:Receiving6. DATE WANTED • .
. A.S.A.P,7. SUGGESTED VENDOR ’
■ j • ** 1 • ,*' .'V ■ ‘1. . •" . -
David £. Lindemuth Co.' Inc., : 1681 Grandview Drive'', ,*South San Francisco,. Ca. . 94080
/ /
- .;v.
riON T
8.IREQUESTED METHOD OF SHIPMENT i
- □ -SURFACE ■ AIR1 FREIGHT * -
□ SURFACE MAIL '
□ AIRMAIL .•'□'OTHER , - ‘
~/u
fj
IF AIR SHIPMENT GIVE JUSTIFICATION
ITEMNO,
- \ * PART No. AND/OR DESCRIPTIONMODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED ’
QUANTITY DESIRED ’v'
ESTIMATED UNIT PRICE {IF KNOWN)
TOTAL ESTI-. MATED PRICE (IF KNOWN)
9. FOR PROCUREMENT ONLY
1. Gas, Chlorine for refill and return to American Samoa Government. J., „ ilSS-cy.
Chlorine Serial No^s ; Listed. , V V. -
1. 420002 819995 11. .4199852. 16551 7. 419963 12. ,4200093. 6110951 • '*■ 8. - 420017 13. .. ,4199824. 6068323 9. 6068304 ,14. ...4199905. ^ 419961 10. 6110925 . 15. , 419996
$78.40 11,176.00
ESTIMATED SHIPPING CHARGES------- :̂ ■ 1294400
TOTAL REQUEST,470.00
SCREENING AND APPROVAL SIGNATURES.••J5
'Hi10. DIVISION APPROVAL 0-S1,000 11, DEPT.JAPPROVAL $1,000410,000.* \ : . ,
BEN M. TAU / Chief Procurement Officer
12.;PROCUREMENT SCREENING
13. BUDGET APPROVAL 14. GOVERNOR APPROVAL-
^PROCUREMENT OFFICE USE ONLY ,
15. PROCUREMENT REVIEW COMMITTEE 16. ATTORNEY GENERAL 17.;PURCHASE-ORDER No.
yn
18. PURCHASE ORDER ISSUED :
19. SHIPPING INFORMATIONA' ^ , V' - :>
\ , ^ - „V*r ** *W
^1; COMPLETE BLOCKSt THROUGH .7 AS INDICATED.^2l CHECK REQUESTED METHOD OF’SHIPMENT IN BLOCK 8.
' 3. ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF ITEM. BE SURE TO'GIVE'QUANTITY'DESIRED AND - ... • .ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES. ®s
DEPARTMENT FILE
/n? ,, .v- .a;--'..-..* -;n - • ->;r-•
/v ?osrgm ; PURCHAS'" REQ ^SITION " " ~ ^
iCCOUNT.No.'t .-v
■ >. (». ' ,V.;^ 17530-5994-
TICAN .' 1A GOVERNMENTPAGO, A. JAN SAMOA, 96799
2. DEPARTMENT,
Procurement OfficeXX *j' \ $? M- .7. 3..TODAV;S<OATE;'>.,^,<’^^.: •/.-
Sept. 27, 1988.„:.
•av.REOUISmON/t'.Jf’" /NUMBER' ' ■•- - *' •
- »--* 1 *A ..-..'pT ^ 85238'4. ORIGINATOR'S NAME A TELEPHONE NUMBER*--,//
M£ Toleafoars
5. DELIVER.TO * *« >,
Shippifagi §,. Receiving. DATE WANTED-
ASAP,7, SUGGESTED VENOOR-;.,'
Day id; K.Lindeauth, Co. Inci ^7
South San Hfancisco, Ca. 94080
5- rf
i**?'
' t*.T ■} e-5;
.•>REQUESTEDJMETHOD OF SHIPMENT^ ■ < -S $Xi-
' □‘surface
■'-'□-AIR FREIGHT;'- ’. =e"\\7“ !-
□ SURFACE MAIL’□ ■AIRMAIL - ' ' :
' □.OTHER
IF AIR SHIPMENTrGIVE JUSTIFICATION;
ITEM- PART No. AND/OR DESCRIPTION ' 4 - ’“QUANTITY ' ESTIMATED . TOTAL ESTI- 9. FOR PROCUREMENT ONLY
Na . , MODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED^ »'■ 4 ';bESiRED:; ‘ (IF. KNOWN)- *• / (IF KNOWN)f • ‘rPR»CE 7 * '7' TOTAL ' A '
1. Emptji Chlorine Gas , for refill and return*. . . • ' . 7
to American;Samoa, Government . >-v 30-cy. $78.40 ^2,352.1
Chlorine Serial No's; Listed. '. ‘ ’- : ' - ’ . p ----- t . _ V
ri 419961 J=tl6L <3116.C-':/' t . .
•; _r • • 1 vC '*
- '' ’ii •'' r ■V 'V -
2V/ 10810 V;: 11. 419977 . ..... v&\' ‘ ‘A’ •; f ••
3l-/ 419966 , 18. 419974 -a . 1 f y "• ■ u . ;l ■" • ’ •
4. 419979. - 19.; 10802 ... . VjT'p.L. ^ V V;5. 419996 20. 419967 , . v ><_■. r '•/.• .-V :6. 419962; . 21./ 6068326- : ' .7. 6110962 22. ,419976 rJ/, x. V-'.V ' . :-7'^;'7v ‘ ;; 7.yv.
8. 419990 23. 420007... . , ' / 7, •■; -
9. ,10780 24. • 419997.'. '10. . 41998S : . 25. 6068298:.' X 7V''r /.y-
Ill 1373 26.- 2217 ■ :J 77m7^; ‘7 ■.■''■7 r\ ■■■
12. 120013 ' 27. 41996513. 10806V ’ 28. ; 6068329' / : ,r‘' '' V -• *14. 10808 29. 41997015. 10320 30. 420001 L r™/' 777^ ' 7 /7-/ ■■ ;v-'-
^ T _
ESTIMATED SHIPPING CHARGES ‘588.00
- J--" !.
. - f t p- , 1 r.
k.v- ; TOTAL REQUEST ; 2;940.0 ’ 1 ■ • ' .
SCREENING AND APPROVAL SIGNATURES'?
10. DIVISION APPROVAL 0-S1,0004 11. OEPT. APPROVAL $1.000-$10 000 -'^. ; *
LA»AU M. SEUIActing, Chief Procurement Officer
12. PROCUREMENT SCREENING
13. BUOGET APPROVAL 14. GOVERNOR APPROVAL
PROCUREMENT OFFICE USE ONLY
,15. PROCUREMENT REVIEW COMMITTEE-*’ r*J'‘ 16. ATTORNEY GENERALH^i;***<■/ ' *V, . At "
17i;PURCHASE.OROER
( tC'f ?- st
18: PURCHASE ORDER.1§SUED _
19. SHIPPING INFORMATION
>/r_ :■? -frl T'rfc.T3~
1 COMPLETE BLOCKSiTHROUGH 7 AS INDICATED/ --P-" - ' J ‘
?' 2: ’CHECK REQUESTED'METHOD OF SHIPMENT IN BLOCK 8.J V- tv"-1 ...... . Ji- .,3! ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTIONOF ITEM. BE SURE TO GIVE QUANTITY DESIRED AND
ESTIMATED UNIT AND,TOTAL.PRICE;IF; KNOWN SHOW ESTIMATED SHIPPjNG^CHARGES:; >r; ^ ;:-;; _.,t
INSTRUCTIONS
' DEPARTMENT FILE . ^■®s-'
r.>
ASGFORM
PURCHASE
• 1. ACCgU
7530-5994
ft.' v V ‘ : c-s-aTf ~ ’ :PAS0p<7\)MERIAMERICAN SAMOA GOVERNMENT
' . 4PAG0 PA,-V AMERICAN SAMOA, 96799
2JDEPAmMENTgrJj'v.!i%^,r,,Ji.«-;j i;.TOOAY'S DATE>;Office of • Frocuremei it:W' flebruary 3, 1989
REQUISITIONS NUMBER -: : I
85387
^“Vs
4. ORIGINATOR’S NAME & TELEPHONE NUMBER
;, M. Toleafoa •
5. OEUVER-TO^-
Shipping & Receiving •< ' ■-£' ;*
>: DATE WANTED -
ASAP
‘ L‘
■ 7. SUGGESTED VENDOR- “• ' ■»'<,» j . , ...•* k ‘ - %•• /■ : - ^ ...' ■-•< ‘.H ■
W David, K. .hindemuth ~ a's- ft; *'^''1681^ Grandview?Drive’ ,,v -'.i 1 ^ **’ *■. South San Francisco/ Ca. . 94080 ;
V„v-•Trr-.r» - ?\f(/~ .v!;/ V-h. ®* TS
I ^ i;
a REQUESTED METHOD OF SHIPMENT*4; '-v
□ SURFACE , ,'tvm:/ . > ‘ LOfew At*’
LJ OUHh^Ut/.. . \x *, J A V;'-.-;.V,
'□-SURFACfMAI^P-:^^/'" 7 //.
AIRMAIL- - -vV A - -□other "
IF AIR. SHIPMENT GIVE JUSTIFICATION-'
ITEM ’ / PART. No.’AND/OR DESCRIPTION'^-''x •V* \..QUANTITY- ;'/ESTIMATED; ' , TOTAL ESTI--. 9. FOR PROCUREMENT ONLY - ; •/ ■' • ■ '
No. • MODEL No. & SERIAL NoZ-OF ITEM FOR WHICH PARTS ARE ORDERED/, :-J DESIRED;. , V.(IF'KNOWN) (IF KNOWN)'.1 , PRICE. TOTAL • - * . ’
1. ' ■ ,?.V - - ■Empty Chiorine Gas* for refill and return'?y -
to American Samoa Government • 30-cy. $78,40 -2,352.0 ) - , ■ - \- V. - . n,;- *■ w * . ^ -V. -*
Chlorine Serial No1a S Listed. -V .
’ -lV. r" - T**':1. -3.6538;^- 16.. 107831 r ( i
•i v 2, : 420018 - 17. 419991 ~ & • ■ ■ ■- - • ;3. ,16545 ft; 18. 1784 t
~r-. ■ -4. 16532 19.~ 6068301 V ' . , ., 1.1 • ‘ • . ' v„ ■ p;/
v?L. A '■5. C16530 20. 10814. -1. . V -v
>■’ ■ ;6. 16558 21. : 16523 * - . ■ , - , "■[' _ 1. it ~“.i ‘or. 1 >• •- ' • r \\ ■•;A L/V i7. 2237 -22. 420016 r ;:.v' •8* 10824 23. 419980 - : . Vi'’.•' • . ( ■ t ’ .9. 420011 24. 6110948. -■-'I' ; /:r < ■ 'C j ' : ' • v J.vv--v -4" ' .. V" ' . -
io. 10792 25. 13121 V ' , \}J'Y •’ ' f:
n. 16557 , 26. 419972 V", -> :F-%:: ■' ;'vv\f' v. \V!12. 6068299 27. 16514 " - . -13: 420010 : ; 28. 16550 . •- : -V-. : - . ' ...14. 10823 29. 42000215. 1763 30. 7728
V -
• ' 1*-.^ »■•' ' ;v, V A 1 ~ 'K«
+.1- ■ r >.■ i ■■■-.
• >•-» ’ ,•ESTIMATED SHIPPING CHARGES " $588.00 7"- i- ;//'
■ ''-f
f-
^ J TOTAL REQUEST $2,940.1 )0.1- FU'' , r
t.., \.:ry.\ SCREENING AND APPROVAL SIGNATUREStr'
■ --10. DIVISION APPROVAL 0-S1.000.
H.A. Lelauti
11. 0Ef>T-. APPROVAL SI.OOO-JIO.OOO^- ^V^ ■ V
— PAUL FELISE ; Chief Procurement Officer
12. PROCUREMENT SCREENING-.
13. BUDGET APPROVAL . 14. GOVERNOR APPROVAL
PROCUREMENT OFFICE USE ONLY
15^ PROCUREMENT. REVjEW. COMMITTEE^Vl-' I6> ATTORNEY GENERAL'.'*
'■%YF
17: PURCHASE ORDER No:/--' 10..PURCHASE ORDER ISSUED .
19. SHIPPING INFORMATION
r;.,' -.'
- '' i.'COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED.' T - □’"'A;; -YrY V-
■::Y ' 2. CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8.>- ; . ’ '' , : - v;-. 'i 3. ALWAYS GIVE'PART NUMBER AND/OR BRIEF-DESCRIPTION OF. ITEM. BE SURE TO GIVE QUANTITY DESIRED AND V - •V‘ ; ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES.> - :- t ■ i
i INSTRUCTIONS
DEPARTMENT FILE
ft;—PURCHASE REp\ISITION ‘
gU\ WT(REV-9/87) r ‘ \ Jc'AMERICAN .’10A GOVERNMENTPAGO PAGO; IlCAN SAMOA, 96799:
Stef-
ft.
■sSfei
Vff T -ACCOUNT No.t.-. - •)
7530-59«42 DEPARTMENT'^,'-, ^
Office of Procurement3 TODAY’S DATE, ‘ t* 7, 7 *
November: 29*^ 1988:REQUISITION -
NUMBER
85286
\ 4 ORIGINATOR’S NAME& TELEPHONE,NUMBER-'-.f4.5
M*.; Toleafoa5.’ DELIVER.TO.v
Shippings Receiving, DATE WANTED.-.*
ASAP X"...\ ■ i'
. 7; SUGGESTED VENDOR. -** • .• V -$*
David. S. UademittCo *iyintgkr, • - 1681 Grandview Drive' \South San Francisco, ,Ca.; 94080
S REQUESTED METHOD OP SHIPMENT; .
.□ SURFACE /.*V * , t Mr's!.. ••»/».•*> •,«''□ ’AIR-FREIGH^;rr;,;y
□ SURFACE MAlL -’
□ AIRMAIL□ OTHER-
V,’ ••..-•■V'r'i A.’-’a-s.s, . 'Vi. .....
IF AIR SHIPMENT GIVE JUSTIFICATION "
V ^
* ’&
ITEM. No. •*'
‘ -PART-No. AND/OR DESCRIPTION’;\ MODEL No. VSERIAL.No. OF ITEM FOR WHICH PARJS ARE ORDERED-: / ♦*’ v.’*'
QUANTITY;.;:, .OESIREO - V:
. ESTIMATED - UNIT PRICE
- (IF. KNOWN) '
TOTAL ESTIMATED PRICE. (IF KNOWN)
9. FOR PROCUREMENT ONLY. ,
IT
2.Emptji Chlorine Gas* for refill and return, to American Samoa Government.;
Empty Carbon- Dioxide; Gas* for: ref111 and return to American Samoa Government. -
--•/.:;-v r’^4V-/ "yv/' / . ::■£/•■' vChlorine Serial No's: Listed. 11. 420006 r ; 11. 6110947 21. 60683362. 420008 12* 6il0956 22* 60683373. 10819 : 13. 419971.-1 23. 61109654. 6068324. 14. 5110945, r 24; \ 107935 ’J: 419981 15. ,6110853 • 35. 60633176. 420017 16. 420004 . 26. 107887. 10809 . 17.; 6068318 ;/27-V-'. 4i99998. 10815 18. 10790 “'■ 28; - 4199689. 3260 19.; 16068336 29. 10804 :10. 6110925 20. 17223
• -- r30. 1827
K1PTY CARBON DIOXIDE SERIAL No*S; Listed*
30-cy.
15-cy.
$78.40 12,352.00
$ 40.00 600. CO
1. 4690 6. 4596 ,11. 3988.
2. 4761 7. 2904/ 12* > 46063. 4933 8. 2920 13. 47934. 4855 s 9. 395t? 14* 48165. 131— 10. 3981
ESTIMATED SHIPPING CHARGES' ‘ 738.00
15. 4660 TOTAL REQUEST^; 8,^o)
SCREENING’AND APPROVAL-SIGNATURES-'
10. DIVISION APPROVAL 041.000 11. DEPT. APPROVAL JI.OOO-SIO.pOO-1' : 12: PROCUREMENT SCREENING. '
BEN M. TAB '..........Chief Procurement Officer
13. BUDGET APPROVAL 14. GOVERNOR APPROVAL
PROCUREMENT OFFICE USE ONLY - , •
.1S. PROCUREMENT. REVIEW COMMITTEE**.^^ , «• -y ’fk
* - / - - ^ J. i>-
16.--ATTORNEY GENERAL-: 13J. PURCHASE ORpER 18. PURCHASE ORDER ISSUED;./.';-V.'
19. SHIPPING INFORMATION 20. VENDOR
r \ t *
_Liy
- v - . INSTRUCTIONS- _ ,• •.-.-’r* ' • .' -c i-j.- •• -'i! 1 .-■i.-. t'.x.. ■*? ~ --^-4' ' .:-v ■.* • m ■ -- ••-'■s?'-..'" - J ■ •. — . ‘" -.-. .. ’1 . ' « - .- > • V C-J-'V •• • .*' V ' • " r~ yi J ‘ -V'.I • . - ,'v . '•* >, >: _ 1 .V;.' - r- t„v'
1' COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. ' " . " ; .
2: CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8. * /- • -3 ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF ITEM; BE SURE TO GIVE QUANTITY DESIRED AND
ESTIMATED UNIT’ AND,'TOTAL-PRICE IF.KNOVVN SHOW. ESTIMATED SHIPPING CHARGES.
DEPARTMENT FILE , / v v'./. ' •
<Bi ■
ASGFORM
f.'-JJiVjj > ; : " ... ' J VMS'- ; I'-'1 iir.i' '■ '"■ — ‘ ‘.
PURCHAF^RkUISITION ~>u>4 -'\«1E RICAN SAMOA, 96799 . '
ffTW). £•?*.' 5.A-'
.yf-x.kk 'k-vkkkIrk'--1: ~> -7«;’0-SQ94
-XY''\ -
V-V
:$r/- t‘>-
-j:’ 3 k
' -.4. ORIGINATOR'S NAME & TELEPHONE NUMBER;-- ^ .,•■;* •
■4W'''MV. T^Ieafofe^^l':
2. DEPARTMENTS'-^:*’'**v
Office of Procureaejnt June?27, 19835. DELIVER'TO, .
^.TODAY'S DATE-'-
Shipping 8? Receiving
REQUISITION;.-;NUMBER^';
.V, •■% - vr’Vi*’.'. -kV/-.kV,.-- ^ ••
701626. DATE WANTED^.
ASAP '
7 SUGGESTED VENDOR ^ ?
'lOS^Grimdvi^^prive^'' - pr.South: Saii rFrancisco, Caw» . 94080
8 REQUESTED METHOD OF SHIPMENT J*, iS*
. □ surface . . k
^[XaIR FREIGHT - ,V ^
?□ JiURFACE'MAVL' k ■ - " »; □ AlRMAIL^V^^' ■ ' k • ■•■:•• Q OTHER ' " **■*;■* v : ‘ '•’
IF AIR SHIPMENT GIVE JUSTIFICATION
l ,«•
ITEMNoT“*
!k-
. . PART No. AND/OR DESCRIPTlON-r • • - .<« ‘ MODEL: No. 4 SERIAL No. OF ITEM: FOR WHICH PARTS ARE.ORDEREO.
Empty ailorinor^s^^fwlrefill^^ return
to American Samoa Government/. . ....
- t: i'i.-21.. * < : j.T— C&Lt-Js' ■,
Empty Carbon Dioxide Gas, for refill and •;
return0 to American Samoa Government-
j-.v ’■ .£< .,.):77q. : ,;V - - Si"‘ 4 ** t c * *"* .(C-» *; Chlorine^SeriaAl No's; Listed.I: l.: 6110921 14.i. ; 169504 a12& 606832S is.: o6110917 28i- 10791
3.V. 6110957 16.] 6068297 29. 10794..:: 4. 61109S9 i7. 6110928' 30.. 10736■ • 5y 6110931 ; /' - 18 » ^ -6068309
6. 2440 . 19 k 10019 :v; ■;■:■■ v',7. 1715 f 20.- - 10796k. ' '.kj-fk-vk
■ 8.- 611095. 21. 10825 “ - t.’ ..-.-X,.r 9.. 419969 22. 611094110. 1082 23. 420012Ill 419986 24. 419993
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12. 419988 25. 419983 CU; 122V13. 420Q03 . :: y- 26k !10782 . ...WT: 2550-
QUANTITYOESIRED
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ESTIMATED UNIT PRICE
' (IF KNOWN)
$78.40r ••- :•j.. ■ ■.
i -4- ■■ -$40.00
$2,352.00
Jl, 000.(0
TOTAL ESTIMATED PRICE (IF KNOWN)
ESTIMATED SHIPPINGiCHARGES$858.00
9. FOR PROCUREMENT-ONLY
CONI'D.
TOTAL REQUEST$4,190.00
SCREENING AND APPROVAL SIGNATURES*.
10. DIVISION APPROVAL‘0-41.000 11. DEPT. APPROVAL $1,000$1p,000 k-. .J k k'
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BEN:tfs-.TAU■'*•**-~Chief PT-orirrement flffirer-
v' 7 y..- 14. GOVERNOR APPROVAL
12. PROCUREMENT SCREENING ' / ■&
13. BUOGET APPROVAL
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' PROCUREMENT OFFICE USE ONLY
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15.- PROCUREMENT'REVIEW COMMITTEE.-.Ik
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17: PURCHASE ORDER No.;:-- - ' ‘
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19. SHIPPING INFORMATION
18. PURCHASE ORDER ISSUED
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P CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8.V? - 3; ALWAy.S'GiyEiPABT NUMBER AND/OR BRIEF DESCRIPTION OF ITEM: BE SURE TO GIVE-QUANTIJY DESIRED AND-
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"DEPARTMENfrar*:>^‘'>tS^!!'fe‘^''':- *■