Appendix 68

Republic of the Philippines

WASTE MATERIAL REPORT

LGU:
PLACE OF STORAGE: DATE:
OFFICE / DEPARTMENT: RURAL HEALTH UNIT NO.:
ITEMS FOR DISPOSAL
ITEM RECORD OF SALES
QTY UNIT DESCRIPTION
NO. O.R. NO. AMOUNT

TOTAL
CERTIFIED CORRECT DISPOSAL APPROVED

CERTIFICATE OF INSPECTION
I hereby certify that the property enumerated above was disposed of as follows

Item ______ Destroyed/Disposed

Item ______ Sold at Private Sale
Item ______ Sold at Public Auction
Item _______ Transferred Without Cost to _ _________________________________

PROPERTY INSPECTOR WITNESSED BY

__________________________________________
C O A / MUNICIPAL ACCOUNTANT / REPRESENTATIVE