LOAD SHEET

DISTRICT __________________________________________________ DATE OF JOB _______________________________________________

CUSTOMER ________________________________________________ WELL NAME ________________________________________________

BRANCH BULK PLANT ____________________ FIELD RECEIPT NO. ___________________ FIELD RECEIPT DATE ______________________

QUANTITY VERIFIED
PRODUCT ITEM
UOM LOADED/ NET TO FIELD
DESCRIPTION NO. ORDERED RETURNED COMMENTS
BLENDED USAGE RECEIPT

COMMENTS:

(Reasons for variance)

ISSUED BY _____________________________ DATE __________ RECEIVED TO LOCATION _______________________________ DATE ______________________

SERVICE SUPERVISOR

RETURNS VERIFIED BY _______________________________ DATE ___________ APPROVAL __________________________________________________________

OPERATIONS SUPERVISOR

CUSTOMER SIGNATURE _______________________________________

Form 1460 OPS-GLB-EN-PP_100243 Rev. C: 23 May 2017