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Republic of the Philippines DOST-GEN-F04

DEPARTMENT OF SCIENCE AND TECHNOLOGY Revision 0


Regional Office No. VI Effectivity Date: 21 Oct 2016
ISO 9001:2008 ISO/IEC 17025:2005 RRG/rcs

Control No. Date May 22, 2018

To
Guard: This authorizes Ma. Alicia Soledad A. Salazar whose signature
appears below to bring out the following property/ies:

Returned to
ARTICLES/Description
QTY. / Property No. R E M A R K S DOST
(Brand, Model, SN)
Unit Date: Received by

1 Canon EOS 700D


1 Canon EOS
1 Projector
1 Projector
1 Projector Screen

Authorized By: Noted:

Ma. Alicia Soledad A. Dr. Emelyn P. Flores


Salazar ARD for Technical Operations Jocelyn Z. Pudadera
Printed Name/Signature
SRS II Department/Division Head Administrative Officer V

Dept./Div./Firm Date Date

ID No.

For GUARD Use Only ( Below this line )

PHYSICALLY Gate Guard ________ _______


INSPECTED BY Printed Name/signature Date Time

Vehicle : Plate No. Brand/Kind

Color

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