Appendix 65

WASTE MATERIALS REPORT

Entity Name : Fund Cluster : _____________________

Place of Storage : Date :

ITEMS FOR DISPOSAL

Record of Sales
Item Quantity Unit Description Official Receipt
No. Date Amount

TOTAL
Certified Correct : Disposal Approved :
ATTY. DONATO D. BALDERAS, JR.
Signature over Printed Name of Signature over Printed Name of Head of
Supply and/or Property Agency/Entity or his/her Authorized
Custodian Representative

CERTIFICATE OF INSPECTION

I hereby certify that the property enumerated above was disposed of as follows:

Item ________ Destroyed

Item ________ Sold at private sale
Item ________ Sold at public auction
Item ________ Transferred without cost to __(Name of the Agency/Entity)__

Certified Witness to Disposal:

MA. LEILANI S. CORTEZ BELLA AQUISAP
Signature over Printed Name of Signature over Printed Name
Inspection Officer of Witness

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