INSPECTION AND ACCEPTANCE REPORT

SK of Barangay:Lunzuran IAR No.:2020-__-000__

City/Municipality: Zamboanga City Date:
Province: Zamboanga Del Sur
Supplier: ZAMBOANGA VJ MARKETING Invoice No. _______________
PO No.: _________________________ Date: ________________ Date: ____________________
Requesting SK Official: Kiemer Terrence R. Sechico
Unit of
Item No. Item Description Quantity
Measurement

Betadine Gallon 3
1
2 Surgical Gloves Box 5
3 Gauze Pad Pack 5
4 Terumo Syringe 3ml Box 3
5 Terumo Syringe 5ml Box 3
6 Surgitech Plaster Packs 10
7 Surgitech Chromic Suture Box 20
8 Alcohol Gallon 5
Lysol Liquid Pcs.
9 10
x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x

INSPECTION ACCEPTANCE

Date Inspected: _______________ Date Received: _______________

X Complete

X Inspected, verified as to quantity

and Specification Partial (Please specify quantity received)

ARSIMAN M. SIDDUNG KIEMER TERRENCE R. SECHICO

Signature over Printed Name Signature over Printed Name
Head, Inspection and Appraisal Committee SK Treasurer