Republic of the Philippines

Department of Education
Region V (Bicol)
MAONON HIGH SCHOOL
Maonon, Ligao City

ACKNOWLEDGEMENT FORM
This is to acknowledge that I received the following raw materials/items
below:

Quantity Raw Materials/Items

1 kilo Pork meat
½ kilo Chicken breast
15 pcs. Quail Egg
¾ kilo White sugar
½ kilo Iodized salt
¼ kilo Garlic
50 grams Bell pepper
½ kilo Carrots
100 grams Red onions
40 grams White onions
6 pcs. Siling Labuyo
50 grams Ginger
1 bundle Singkamas

Nothing follows

Release by:

NOAH R. LOBITAÑA Date: ________________________

Food Laboratory In – Charge
Work Immersion Coordinator

Received by:

_______________________ Date: ________________________

Signature over printed name