FADZY AQUACARE WATER REFILLING STATION TMO Bldg., National Hi-way, Purok Matco, Panalsalan, Plaridel, Mis.Occ. Contact Numbers: Globe (09956008464) and Smart (09085442933) Email Address: aquacarewaterrefillingstation@gmail.com NAME OF OFFICE: ee eee estes eee eee ADDRESS: eae CONTACT NUMBER: I HEREBY ACKNOWLEDGE that I received the following AquaCare property: NAME OF ITEM NUMBER OF ITEMS | DATE OF RECEIPT Water Dispenser 1 1128/2019 (Eureka brand worth Php5,800.00) Gallon 5 11/28/2019 (round water container, worth Php120.00) TAGREE to keep the property in working condition and to notify management should the property malfunction in any way, or should the property be lost or stolen. Further, I agree to pay the amount equivalent to the item/s borrowed and received. When I no longer need on or more of the items, I will return itvthem immediately. Signature Over Printed Name Designation Date Approved by: i (DAM ‘Owner (AquaCare) Address: "RTC Branch 74, Cebu City Cebu City Hall of Justice Qimonda IT Center, NRA. 6000 Cebu City Contact No: 09173037691 / 09109693355