SAMPLE LABBL -TANK LORRY DETENTION SAMPLE SAMPLE LABBL -TANK LORRY DETENTION SAMPLE

DRAWN AT RETAIL OUTLETS DRAWN AT RETAIL OUTLETS

SULLY LOCATION :JUNNARDEO DIVISION/TERRITORY/RECION Jabalpur SULLY LOCATION :JUNNARDEO DIVISION/TERRITORY/RECION Jabalpur
1.        Name & address of the Re-oil Outlet : BHAIYAJI FUELS 1.        Name & address of the Re-oil Outlet : BHAIYAJI FUELS
2.        Name of the Oil Company : Indian Oil Corporation Ltd. 2.        Name of the Oil Company : Indian Oil Corporation Ltd.
3.        Product : MS 3.        Product : MS
4.        Source of sample : LORRY TANK 4.        Source of sample : LORRY TANK
5.        Tank Lorry No : MP04 GA 1831 Invoice No : 759163241 5.        Tank Lorry No : MP04 GA 1831 Invoice No : 759163241
6.        Sample on 10-10-2022 at 11:00 PM hours 6.        Sample on 10-10-2022 at 11:00 PM hours
7.        Density at 15 Deg. C 7.        Density at 15 Deg. C
a) As recorded in the chamber : 754.600 a) As recorded in the chamber : 754.600
b)Of sample collected from the lorry : b)Of sample collected from the lorry :
8. Ro tank No. of product decanted : 02 8. Ro tank No. of product decanted : 02
9. Plastic seels No. of Aluminium container : 24744 9. Plastic seels No. of Aluminium container : 24744
10. Plastic seels No. of Wooden Box :24744 10. Plastic seels No. of Wooden Box :24744
Certified that emply containershad been recvied with the product before Certified that emply containershad been recvied with the product before
drawing of sample my prescnce and the sample is retaind after proper drawing of sample my prescnce and the sample is retaind after proper
labeling and sealing. labeling and sealing.

Signature of the Dealer Dealers representaive……………………………….. Signature of the Dealer Dealers representaive………………………………..
Name of the Dealer/dealer’s representstive : BHAIYAJI FUELS JUNNARDEO Name of the Dealer/dealer’s representstive : BHAIYAJI FUELS JUNNARDEO
Seal/ : BHAIYAJI FUELS JUNNARDEO Seal/ : BHAIYAJI FUELS JUNNARDEO

Place and Date : JUNNARDEO Place and Date : JUNNARDEO

Signature of T/L driver : ………………………………………………….. Signature of T/L driver : …………………………………………………..
Name of T/L deiver : MONU Name of T/L deiver : MONU
Transporter’s Name : JAY MAA TRANSPORT Transporter’s Name : JAY MAA TRANSPORT
Oil Company : Indian Oil Corporation Ltd. Oil Company : Indian Oil Corporation Ltd.
 SAMPLE LABBL -TANK LORRY DETENTION SAMPLE SAMPLE LABBL -TANK LORRY DETENTION SAMPLE
DRAWN AT RETAIL OUTLETS DRAWN AT RETAIL OUTLETS
SULLY LOCATION :JUNNARDEO DIVISION/TERRITORY/RECION Jabalpur SULLY LOCATION :JUNNARDEO DIVISION/TERRITORY/RECION Jabalpur
1.        Name & address of the Re-oil Outlet : BHAIYAJI FUELS 1.        Name & address of the Re-oil Outlet : BHAIYAJI FUELS
2.        Name of the Oil Company : Indian Oil Corporation Ltd. 2.        Name of the Oil Company : Indian Oil Corporation Ltd.
3.        Product : HS 3.        Product : HS
4.        Source of sample : LORRY TANK 4.        Source of sample : LORRY TANK
5.        Tank Lorry No : MP04 GA 1831 Invoice No : 759163241 5.        Tank Lorry No : MP04 GA 1831 Invoice No : 759163241
6.        Sample on 10-10-2022 at 11:00 PM hours 6.        Sample on 10-10-2022 at 11:00 PM hours
7.        Density at 15 Deg. C 7.        Density at 15 Deg. C
a) As recorded in the chamber : 827.700 a) As recorded in the chamber : 827.700
b)Of sample collected from the lorry : b)Of sample collected from the lorry :
8. Ro tank No. of product decanted : 01 8. Ro tank No. of product decanted : 01
9. Plastic seels No. of Aluminium container : 24744 9. Plastic seels No. of Aluminium container : 24744
10. Plastic seels No. of Wooden Box :24744 10. Plastic seels No. of Wooden Box :24744
Certified that emply containershad been recvied with the product before Certified that emply containershad been recvied with the product
drawing of sample my prescnce and the sample is retaind after proper before drawing of sample my prescnce and the sample is retaind after
labeling and sealing. proper labeling and sealing.

Signature of the Dealer Dealers representaive……………………………….. Signature of the Dealer Dealers representaive………………………………..
Name of the Dealer/dealer’s representstive : BHAIYAJI FUELS JUNNARDEO Name of the Dealer/dealer’s representstive : BHAIYAJI FUELS JUNNARDEO
Seal/ : BHAIYAJI FUELS JUNNARDEO Seal/ : BHAIYAJI FUELS JUNNARDEO

Place and Date : JUNNARDEO Place and Date : JUNNARDEO

Signature of T/L driver : ………………………………………………….. Signature of T/L driver : …………………………………………………..
Name of T/L deiver : MONU Name of T/L deiver : MONU
Transporter’s Name : JAY MAA TRANSPORT Transporter’s Name : JAY MAA TRANSPORT
Oil Company : Indian Oil Corporation Ltd. Oil Company : Indian Oil Corporation Ltd.
 SAMPLE LABBL -TANK LORRY DETENTION SAMPLE SAMPLE LABBL -TANK LORRY DETENTION SAMPLE
DRAWN AT RETAIL OUTLETS DRAWN AT RETAIL OUTLETS
SULLY LOCATION :JUNNARDEO DIVISION/TERRITORY/RECION Jabalpur SULLY LOCATION :JUNNARDEO DIVISION/TERRITORY/RECION Jabalpur

1.        Name & address of the Re-oil Outlet : BHAIYAJI FUELS 1.        Name & address of the Re-oil Outlet : BHAIYAJI FUELS
2.        Name of the Oil Company : Indian Oil Corporation Ltd. 2.        Name of the Oil Company : Indian Oil Corporation Ltd.
3.        Product : XP 3.        Product : XP
4.        Source of sample : LORRY TANK 4.        Source of sample : LORRY TANK
5.        Tank Lorry No : MP16MO04H1055 Invoice No : 737370992 5.        Tank Lorry No : MP16H1055 Invoice No : 737370992
6.        Sample on 15-12-2020 at 9:00 PM hours 6.        Sample on 15-12-2020 at 9:00 PM hours
7.        Density at 15 Deg. C 7.        Density at 15 Deg. C
a) As recorded in the chamber : 823.800 a) As recorded in the chamber : 823.800
b)Of sample collected from the lorry : 822.900 b)Of sample collected from the lorry : 822.900
8. Ro tank No. of product decanted : 03 8. Ro tank No. of product decanted : 03
9. Plastic seels No. of Aluminium container : 2474924741946 9. Plastic seels No. of Aluminium container : 2474924741946
10. Plastic seels No. of Wooden Box : 2474A91946 10. Plastic seels No. of Wooden Box : 2474A91946
Certified that emply containershad been recvied with the product before Certified that emply containershad been recvied with the product
drawing of sample my prescnce and the sample is retaind after proper before drawing of sample my prescnce and the sample is retaind after
labeling and sealing. proper labeling and sealing.

Signature of the Dealer Dealers representaive……………………………….. Signature of the Dealer Dealers representaive………………………………..
Name of the Dealer/dealer’s representstive : BHAIYAJI FUELS JUNNARDEO Name of the Dealer/dealer’s representstive : BHAIYAJI FUELS JUNNARDEO
Seal/ : BHAIYAJI FUELS JUNNARDEO Seal/ : BHAIYAJI FUELS JUNNARDEO

Place and Date : JUNNARDEO Place and Date : JUNNARDEO

Signature of T/L driver : ………………………………………………….. Signature of T/L driver : …………………………………………………..
Name of T/L deiver : RAMJI Name of T/L deiver : RAMJI
Transporter’s Name : CHANDRA PRAKASH TRIVEDI Transporter’s Name : CHANDRA PRAKASH TRIVEDI
Oil Company : Indian Oil Corporation Ltd. Oil Company : Indian Oil Corporation Ltd.