ASG FORM ; PURCHASF‘ ASG^.- FORM 672 (REV. 7(71) ^ TSfiEour^a /PURCHASE REQrSITION AMERICAN SA' ^A GOVERNMENT PAGO PAGO, A^, .N SAMOA, 96799 2- DEPARTMENT 3. TODAY’S DATE 7530-5994

ASGFORM ■;

..,672 |REV. R/87),PURCHASF

L 4. ORIGINATOR S NAME 4 TELEPHONE NUMBER - • 5. DELIVER TO. ''l'' " : 1 i'' 6. OATE WANTED SFUND RECORDS CTR ■

M.A. LKLAUYI ‘‘ •\.t SHinoims & Receiving ■ -"V \ ' Askp 5103-00006 !

757330-5994

5^tef!t1,, .• ,j-/-,>■■■

to3 * ■ -i -C

SJICAN SAMOA GOVERNMENTF VAGO. AMERICAN SAMOA 9679S . . .

^ .'■VI'' 'V.’ * • , - ■ ' ’. ' V- __

3. rODAYSDArt,.-,.;. .Jr,-. *•■!> >• V, •.s. ■<;.*]>■ •; --41 •*,■< ;p1442 *'

DAVID K^:LIHDEHDTH CO. LTD. .

BR1SBME, CALIF. 94005 ' '

*'v. V.

REQUISITION NUMBER' |

09861 !

□ SURFACE,.:

□ AIR FREIGHT

□ SURFACE MAIL

: Q-airmail'.

□ OTHER

SFUND RECORDS CTR

88224741

IF AIR SHIPMENT GIVE.JUSTIFICATION

« PART No. AND/OR DESCRIPTIONMOOEL No. A SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDEREO

QUANTITY OESIRED -

ESTIMATED UNIT PRICE (IF KNOWN)

TOTAL ESTIMATED PRICE (IF KNOWN)

9. FOR PROCUREMENT ONLY

1. GAS, CHLORTNE, Comaetiial grade,low pre

ssure liquefied. 150 pound capacity perl

cylinder. For: chlorinating water supply

system.■ (REFTI.I.AKI.R CYLIHDER) vV

: . '-V'-1' \ . .'V./’'i£-TcLT V'.~ ■ . ■■ .

"M0IE::EMPTIES CYLINDERS SHIPPED ABOARD POLYNESIA V-1Q4NB UNDER B/8

#PLL021999 DTD 8/21/92. EMPTIES ARE TO BE REFILLED & RETURNED TO ASG.?

75-cys. 78.40 $5,880. K)

ESTIMATED SHIPPING CHARGESi. ,

I„200000■ C,.',Cv'/v -?f"

■ •/' .' ‘. s • “1'' ;

TOTAL REQUEST

$7^080,00

SCREENING AND APPROVAL SIGNATURES ''

11. DEPT. APPROVAL $1,000-$10.000 '. - - •,/ ■■ ■■ v ' ' ' •

PAUL FELI5E

Chie#_pgocttreBe?fe^|(|lôrL

12. PROCUREMENT SCREENING

• PROCUREMENT OFFICE USE ONLY

.15. PROCUREMENT REVIEW COMM. ,t.<? 16. Ap’ORNEY GENERAL... .17: PURCHASE OROER No. ..

v-: • ,r•18. PURCHASE ORDER ISSUED'.

1S. SHIPPING INFORMATION

u , j INSTRUCTIONS'i.- 'COMPLETE BLOCKS i THROUGH 7 AS"INDICATED?-'"’ 4 ~' V ‘ ?-WVc.:r; ' V?’ . V-"'

2. . CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8.1 ALWAYS,GIVE,PART;NUMBER AND/OF?; BRIEF DESCRIPTION Of= ITEM. BE SURE TO GIVE QUANTITY DESIRED AND

' - ESflMATEiTUNlTAND/fOTAL^PRICE IF,KNOWN SHOW ESTIMATED SHIPPING CHARGES. •

• ' DEPARTMENT FILE ... ' „

T"0*

u ASG-r x ^--’FORM.y

r\7%>~-1krr

PURCHASE RET / V#* >$4*AMERIC %AMOA GOVERNMENT

1. ACCOUNT No. v.' 2. DEPARTMENT -7530-5994','\.i%,' Office' of;

. . . 3. TODAY'S DATE f *

Procurraien ; January 16, ,1980 ,rREQUISITION w :•NUMBER ■*. UU0 4b

v jh- t -w £*: ■ • ' •„ ' '4 ORIGINATOR'S NAME & TELEPHONE NUMBER ) ; '.M-?,*.,.' ■ M.^Toleafda>*’ - ‘ 5 DELIVERTO ' • '. iy - ' '• ‘j

Shipping & Receiving yy' '”-i.:6:datjWanted.--‘ , , , , ,

ASAP " 7,

■ -.7..SUGGESTED VENDOR ... • > . '' >■ f? \ : f, , ’.. ■ t--. y" y < :<'<■.<;< y' ■

David K. Lindemuth Co., Inc.

-^1681 Grandview Drive

South San Francisco, M. 94080

* '»■ 1 ...... •, ", k V,- . A- ' ■ •. ■; ", Vr. *7

.* _ •*■>' u /y-V! " . v •• :'7; y. y.'s J: ■ /V/;

reouested'method of shipment f 1 ' ,.□SURF^CE^yrilvV^'^ / ‘r ■

, □ AIR FREIGHT y' ‘ '

>□ SURFACE-MAIL 7 ’ - '* y ',

, □ AIRMAIL ........... .

..□ OTHER ,l ”•

IF AIR SHIPMENT.GIVE JUSTIFICATION. . ■' • .'’ "Z t'- ■ • '.a*.*? fr

.• »y:'- y.y-: . i'jrf J’/f y ■ T - l, :

•V - 1

item'

No.

' . * ■ y1-' ’ PART No. AND/OR DESCRIPTION ’

MODEL No. S.SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDEREDQUANTITYDESIRED

ESTIMATED’

< UNIT PRICE - . (IF KNOWN) ’ ’

TOTAL;ESTl- »• MATED PRICE (IF KNOWN)

9TOR PROCUREMENT ONLY 1 • -

PRICE ' . \-. " - TOTAL

Empty Chlorine, Gas,N for refill and ' / .*r '' j- ■ \ -r-.jv;

return to American Samoa Government. 30-cy. $78.40, $2,352.( <

Chlorine Serial No’s; Listed.vy <

‘ ’ . ..a;

■> frif >/r;‘\ v.-fe-’ '

C‘ *• ■■- !. ,*V -. 'v. • •

■<£r.v-

1. 811124 : 16. 10802 y -</ . -. - ; V2. ,16543 17. 419997 ••.. *'

; r:wv v1-

-419977 f / 18. 6068327 L . ~ .y ' . / / ;J f:

4. 16555 ■‘-vC' 19. 6068298 • ’ < r •' t y? 7! T. y. ..

«O03®O898 20. 6110962 . •’ : . i;-1 v I-. ....) . ■ ■

21. 4199667. 4120007 22. 419963 ■■■8. 6068328 23. 419982 :9 . 3114 419970 , - > - •■<-?■< i >-y^' '> •'

’'I* '■ ’ , ■ ■'10. '1368 25. 419976: /" ■T*T' ■7^-.. .

■-T ' 11. 811136 26. 811117 ; -V. , %-',v

■ ■ 'y. 12i <811153 27. 811805^13. 811141 28. 811146 v .v

a.. . V ’. •; ' -T

14. 811100 29. 811145 >.-yr ; : y 7

15.: ,811119'S •• .*" 5. is. • ’ >*SV - *

• ; 30. 811125 t. , ' _;'• T'l';

, y/jW'

;■ ,<•<•:

* V; v ; ’-V..;- ‘J* ESTIMATED.SHIPPING CHARGES $ 588.0( ) A

r, •*•;•*•*••* -} :< /.v -Tv yy

; • • ;4.'TOTAL REQUEST $ 2,330.O(

. ' **.

• --j .•

>. .^ •; •

SCREENING AND APPROVAL SIGNATURES

10. DIVISION APPROVAL 0*1.000 -?“■ i.A.'LELAUTI -

Manager, Property & Supply

11. DEPT. APPROVAL $1,000-$10.000 ' *;• 'i;.'5.'"' ' ^£3*; PAUL FELISE

Chief Procurement Officer

12.' PROCUREMENT. SCREENING.

13. BUDGET APPROVAL^* l -■

V/. '* .> . f

14. GOVERNOR APPROVAL' v‘'"‘<,

f vr PROCUREMENT OFFICE USE ONLY

.15. PROCUREMENT REVIEW COMM.

\.r •' -2

16. ATTORNEY GENERAL. >,>. .'7 V. •” 18. PURCHASE ORDER ISSUED

19. SHIPPING INFORMATION

.VXr . 4% v INSTRUCTIONS

1 .COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. ' * • " *• ”2 ’ CHECK REQUESTED METHOD OF.iSHIPMENT IN BLOCK 8.;" X'\ S r* -'-C'-. ' '* *<, , V '£ ,‘\

\ 3 ALWAYS GIVE PART N UM BER.AND/OR :BRIEFiDESCRIPTION OF ITEM.;:BE SURE TO GIVE QUANTITY DESIRED..AND\: ■■'ESTIMATED UNIT AND TOTAL PRICE'IF KNOWN'SHOW ESTl'KilAtED SHIPPING CHARGES ’’ '

ts‘V • .-y^l . , y DEPAI?TMENTjFILE _ '• , ,

rj .

'??«/■ '- PlIRnH'A^F RT‘'•'•IIÎTinN AMFRir QAMDA rtfU/FPNMPNT

FORM ...H?;;.-^672|REV. 9/87) :-f

%£ ,<v< account No ‘

'fev;

PURCHASER'- "JISITION,/Vt. ..it* ‘ •'’"IV i

AMERN SAMOA GOVERNMENT

S; PAGO PAG^ .cRICAN SAMOA 98799

7530-5994

2. DEPARTMENT*• °;i ‘ r 'it

3.T00AVS DATE;' .;..jj:

Office o£fProcuressat i September 8, 1REOUISITlON-

)89BER-,‘'00302

low

,".3*1* r- v.v.4. ORIGINATOR'S NAME & TELEPHONE NUMBER .

M.A.LelautiS.OELIVEflTO

Shipping & Receiving, Tafuna.6. OATE WANTED' , . -

v'C. ASAP'7. SUGGESTED VENDOR •

David K;, I^ndeamth^Gd^xinctfC1681 Grandview DriveSouth San.Francisco, CA . 94080

S..REQUESTED METHOD OF SHIPMENT

.'□SURFACE;;:- ,

□ AIRFREIGHT- i ,f ■* » > -•)' rt Lt- "• u-*[ *□ SURFACE MAIL , IT;

■m.v'A

□ AIRMAIL . .. J "V1H;-.,

□ OTHER -

IE AIR SHIPMENT.GIVE tlUSTIFICATiONi.'

IT.&N

W-:

ITEM ,.N *■' -• PART No. AND/OR DESCRIPTION ' •" ■ t ' . - QUANTITY ’ ESTIMATED- }' UNIT PRICE ;

‘(IF KNOWN) .-,

TOTAL ESTI- 9. FOR PROCUREMENT ONLY

MODEL No. & SERIAL No OF ITEM FOR WHICH PARTS ARE OROERED DESIRED, r, (IF KNOWN)'PRICE / •' ' .• TOTAL -

tEmpty Chlorine,Gas» for refillaand return

■; . ."■'T ' ’ '■ -

‘M' to American Samoa Government. 30 cy. ;,'v;$75v40 *2,35? 00 , . i.

1, Chlorine Serial Noei Listed ■ ~ ; “ _ ■ - ,. !_■ V . 4.’-'^ **- 4- i;.V ■■■•'...

1. 811096 15. 8110963 . i t.',; '

2. 811121 17. 6110952

l8i 10780;>’1-- •

3. 811113•' /; . -i '"' ••tr t •

4. 811192 19. 6110949 ‘ * „ r’ • :v.- -■ ;X-.

5. 811155 20.420000V‘>.f «

6. 811116 21. 6110935 T, '"V'D'v'i”7. 811114 22. 41127; . ■* ' -3'^ . .-i. • ■ " • " •'8. 811156 ' 23 V 603334 j -

: ■ '• • ^ . 8. 81113i :l.'l 24. 2876 ■, I’; .44- '>■' •' ■ ■ ‘

110.811127 25. 419964 t’ V... ..VVrV : r, ■

11. 811139 26. 811097 i' • 4 ''- -V'; '444'V -X . ~’ ■.

12. 811129 27. 811101 ; 4 " .13. 811137 28. 811151 /

14. 811115 29. 8164 .: : '■ ■ T. •

15. 811139 30. 6110932- -F.:

*" • -- ; .iVi-VrViiv.

■ >?-N: . - •; '.'V *•. ' • .... ESTIMATED SHJP_PING CHARGES I88S( 00 ’V.....‘

'.'i: i i R EQUES.T,; $2,940,

>-o

SCREENING AN^/ApROVAL,SIGNATURESV": ii:'.' ■ ‘ -‘-y ' • -• . ■ . ... _

IIS’

1% v; •

v• ■' -

IflPBtvrSÔN APR»eVAL oyrooo .v

4 vM.A. LELAUTI ;

11. DEPT. AP/

CHIEF PEjOCUREMEHT OFFIBBR;


13. BUDGET APPROVAL 14. GOVERNOR APPROVAL

PROCUREMENT OFFICE USE ONLY* / p

15 PROCUREMENT REVIEW COMM.-

- v . '.,v’ A,'

16L‘ ATTORNEY. GENERAL.: 17.-PURCHASE ORDER No v- 18. PURCHASE.ORDER ISSUED

Vv.r

19. SHIPPING INFORMATION 20. VENDOR

.V /VI

INSTRUCTIONS1. COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. . ' ' . . "" .2. CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8. ■ /i " .3: ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF;ITEM, BE SURE TO GIVE QUANTITY DESIRED AND V i

ESTIMATED UNlf AND TOTAL PRICE IF KNOWN SHOW EStlMATED SHIPPING CHARGES. ’. ...........; V' r: “ " .;-.11

■ DEPARTMENT FILE.'. T

MM

“>y\

J&U.. ' *. PURCHASE REQUISITIONMUSI'S /■>-- •' •■

/".-I ACCOUNT :-'..Vt5»'-vy- ■';' W.\\, 2 PEPA^TMENT > •■ .<''jfcl'(;&;v '-aft^S .3. TODAY'S date , ^ , ■•;

' X"- .' ,^' 7*5

7S3<M994 Office of grucureraeit May 15, 1989

AMEfl{C \N SAMOA GOVERNMENT

,-• ■-•PAGOPr 'jMERICAN SAMOA 96799 , ..

REQUISITION'NUMBER. '.’•;

00363

,£;i.'SV>■SsS®

•gS?

4! ORIGINATOR'S NAME » TELEPHONE NUMBER 'H. A.:‘;Leiautii*; .,£ •&;»*

5?oEL(yERTo^.»i.;/-.i|yv^:;'.i/',...’■’tfV'f /

'Shipping ^ Receiving, Tafuna6. DATE WANTED

ASAP". 7: SUGGESTED VENDORS

sSSkv&V;/ca? ,H ■{.A7?:yr-J- ■

ft- T*k-

*'DavidsK.LlndeiaathCo.Încrf681»6raBdvdtew>Dfive^’'-''-'':î''i "> .'‘■'n'veWSouthSaa Francisco, Ca. 94080

S^REQUESTED METHOD OF SHIPMENT* ‘';r ’’ ' • “

•□SURFACE ' , • ‘ ■

- ■' jiv •

□ SURFACE MAIL •• .

v □ airmail. LV.r V-.l1 :'/VjV ' ’ t. s-

□ OTHER o.■;

‘jF AIR SHIPMENT GIVE JUSTIFICATION •> . *' l' t’

ITEM PART No. AND/OR.DESCRIPTION * ' QUANTITYESTIMATED ' TOTAL ESTI- 9. FOR PROCUREMENT ONLY

MODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE.ORDERED. ^ DESIRED • {IF KNOWN) ' . {IF KNOWN) PRICE TOTAL

1. Empty Chlorine Gas , for refill and return Y

„,to American Samoa Government. 45-cy. $78.40: 13,528.0 0 ■

Chlorine Serial No *s; Listed. > -i’’* l; V

-■'M- 1. 6110919 18. 16520 35. 419992 .';L::r:--\ •*

2w .6554* '*;■ .4" 19. 6110938 36. 419984v.

3. ' 419978 20.. 10817 • ,37. 6110927 ■’t ? - . 1 r"'-- .--r• * -

4. 6110951- : 21., 5806 38. 419975• ■>:

\ ■i' ; - •' . '• .

" .~T'5. 10784-: 22.. 3207 39. 16559 "

. ■*/.**.•■ '■: •/

. . . ■■

6. 420009.' v23.. r 10788 40. 6068333 _K.. '

, .7. 418998 24. ' 16541 ; 41. 6110946 L'V"

8. 16549;: 25'^ 6068322 42., 2159 vr".;. r . ■ "V- ■- ■ ’ .

9. 6110918 26. 3226 43. • 2324 J

’ s 10. 6068306 27 i 419990 44. * 6068304 ,V- ■■ ;; “ >r’-.s 1 >' .

.. " .• '.L

-: ■ 11. 419973 28. 16519 - 45. •/. 16552 '

12. 16521 ■*> 29. 16528 1-1 ■ Vi-V"'J * -■*V •• ' \u-. r ;

13. 419989 30. 16553 .' ■ * •

14. 419994 r 31., 6068302' - . . s— •

. .•, ■- .. ■L' , w • • .

15. 6068307 32. 6068335

16. , 10813 . 33. 419987• ’ • .\.V. v

17./ 16551 ^ 34. •- 16536■V • ■'

1' : ' ’ - J*'; ’ ■v,‘ '

•’ —> .• ..

>.•ESTJMATED SHIPPING CHARGES $882.00

j ’ . __ .• ..." /iJf

tJ ;T vCi > .■. ■

TOTAL REQUEST ; 4,410.0 3 ;t

■ ‘.-V- .<■'


10. DIVISION APPROVAL 0*$1,000"

M.A. LELAUTI

11. DEPT. APPROVAL $1.000:$10,000',

PAUL FELISE Chief Procurement Officer



V '£ » <1 *>

PROCUREMENT OFFICE USE ONLY ..

15. PROCUREMENT REVIEW COMM.- -: 16. ATTORNEY GENERAL .7 17: PURCHASE ORDER No:':" ttt.PURCHASE ORDER ISSUED'^


4 *

V_ p fte

INSTRUCTIONS1. COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. /: V ................................

2. CHECK REQUESTED METHOD OF SHIPMENT.IN BLOCK 8.;,. J '-

3. ALWAYS GIVE PART NUMBER AND/OR BRIEF,DESCRIPTION.OFilTEM. BE SURE TO GIVE QUANTITY DESIRED ANDuV ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES. ■. " '

DEPARTMENT) FILE

‘ ASG^.- FORM672 (REV. 7(71)

^□TSfiEourâ

/PURCHASE REQrSITION AMERICAN SA' Â GOVERNMENTPAGO PAGO, A^, .N SAMOA, 96799

2- DEPARTMENT 3. TODAY’S DATE

7530-5994 )ffjce of Procurement November 19, 1987. 4. ORIGINATOR'S NAME & TELEPHONE NUMBER

M. Toleafoa

5. DELIVER TO

Shipping § Receiving

REQUISITIONNUMBER 53391

6. DATE WANTED •/-□ ■ ’

7. SUGGESTED VENDOR

-;■ David K.;-Lindemuth Co.; Inc., „• 1^81 Grandview ’-Drive - South San Francisco, Ca. 94080

-c- >

8 REQUESTED METHOD OF SHIPMENT

□ SURFACE , '

^□/AIR FREIGHT - _ /□:?SURFACE MAIL ’

.□airmail, ; ■

□ OTHlRif A[R SHIPMENT GIVE JUSTIFICATION

‘ ,:y.r;■* /?" Tf-V. •_ ^ ,V.v J-

ITEMNo.

1.

*v •, k'VPART.No. AND/OR DESCRIPTION ■ ' 'V'MODEL No.'& SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED

Gas, CHlorine for refill and return to American Samoa Government... ..... ►

Chlorine Serial No*s; Listed.

1. 6170938 11. .1784 k21.y::' -16523

2., 2324 12. 10783 : 22. .6068329

3. 16519 13. 6110928 23. 31144. 16928 • 14. 3116 / 24. 16558 V

5. 3200 15. 10809 V 25. 6068300

6. 6068325 " 16. 10819 26. 16530 v

7. 16545 17. “■ 6110949 27. 419970

8. 1368 /-a"* 6068319 28., 6068299

9. "6110963 •19. 6068326 29. 10821

10. 6110935 !> 20, 6110950 30. 16521

• Cu; ,122*Wt: 2400-lbs.?

QUANTITY • ■ ‘ DESIRED

30-cy. $78.40.§

-.ÊSTIMATED . ■ 'UNIT PRICE

(IF KNOWN)'

ÊSTIMATED SHIPPING CHARGES ,

7 TOTAL REQUEST

TOTAL ESTI- ' MATED PRICE {IF KNOWN)

$2,352. 00

1588.00

$2,940.( 0


SCREENING AND APPROVAL SIGNATURES •

10. DIVISION APPROVAL 0-S1.000 11 .' DEPT.‘APPROVAL $1,000-510,000 . „ , L,

L.M. SEUI i leting,;Chief Procurement Offic»

13. BUDGET APPROVAL

12.' PROCUREMENT.SCREENING

14. GOVERNOR APPROVAL v

•PROCUREMENT OFFICE USE ONLY

. 15.-BIDDING DATE-MAILED 16. DATE BID AWARDED '


17,‘PURCHASE ORDER No. 18. PURCHASE ORDER ISSUED

JINSTRUCTIONS

. 1 COMPLETE BLOCKS I THROUGH'Z’AS INDICATED ' , - ' V '-.’V ” - '**2 CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8

• 3 - ALWAYS GIVEJPART.NUMBER AND/OR.BRIEF DESCRIPTION;OFvlTEM:®E SURE TO GIVE QUANTITY,DESIRED.AND %'^s ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW-ESTIMATED SHIPPING-CHARGES.

DEPARTMENT FILE

;:sv: -•/. v-;-4

ASG

Rl\

REV. 9/87)PURCHASE REf ISITION AMERICAN—'10A GOVERNMENT

PAGO PAGO, \ JOAN SAMOA, 96799

1. ACCOUNT No '»:.1

7530-59942. DEPARTMENT . V v

Office of Procurement3. TODAY’S DATE • - v : .

January 12, 1988.REQUISITIONS

NUMBER 700024..ORIGINATOR'S NAME & TELEPHONE NUMBER.

M. Toleafoa5. DELIVER TO

Shipping 6 Receiving6. DATE WANTED

A.S.A.P,7. SUGGESTED VENDOR

,David K. Lindemuth Co. Inc.,; 1681 Grandview Drive'South San Francisco; Ca. 194080

8. REQUESTED METHOD OF SHIPMENT .

□ SURFACE

□ AIR FREIGHT<. .

„□ SURFACE MAIL

□ AIRMAIL

□ OTHER

IF AIR SHIPMENT GIVE JUSTIFICATION

ITEM No. • V- , ■ PART No. AND/OR DESCRIPTION’^-MODEL-No.& SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED •’ " ->i" >>• ! QUANTITY../- DESIRED

.-ESTIMATED ., UNIT PRICE. -t- •.(IF,'KNOWN) •/■'U.-TOTAL ESTI-. /MATED PRICE (IF KNOWNJVv

.9, FOR PROCUREMENT ONLY ...PRICE 1 "... ■■ TOTAL ' / •'

1, Gas , Chlorine for refill and return to . . : , • - ~

£ :.F' /! '

American Samoa Government. 45-cy. $78.40 >3,52S.( 0 '. .- • •

*»• *■. V. t" :Chlorine Serial No's; Listed. 4 • .r-• --V.

• •

1. 6068322 15. 420011 89. .419999 43. a: 0010h I.**- <\ ■' * .r f

2. 6110962 16. 10784 30- 10789 -44.:7: '29 /V: < f -3. 10808 17. .419968 ,31. 6068302 45. 6( >68324 v)..4. 16532 18. 3260 32. 16550 ; -5. 6068830 19. 2237 ... 33. 819966. ..6. 6068318 20. 10814 -34. 10790 . a , ’-J ' ' /■' - "/> - -- ' *• • -V

7. 13121 , 21. .10815 35. -419972 v % fj, t '"iMk8. 6110947 ' 22. 1575 36. 806836 \ '9. 419971 “ 23. 6110953 -37. 419994

, r ...-F

10. 6110945 24. 16538 .38. 1011 -} * V

-.1 - vT--. .*. jr. . c , .

11. 16554 25. 420013 39. 611096512. 16552 26. 10806 40. 2159 : ’v13. 1827' 27. 419984 41. 611093214. 16549 28. 6068299 42. 420008 - '

' -v — / C" •'V/ £ ft', r , __ESTIMATED SHIPPING CHARGES

S882.00

,,„r, TOTAL REQUEST- $4.410.C 0


10. DIVISION APPROVAL 041.000•-V-' ' • .,

11. DERT. APPROVAL S1.000 J10 000

BEN M. TAUChief Procurement Officer

12.-PROCUREMENT SCREENING


PROCUREMENT OFFICE USE ONLY .

15. PROCUREMENT REVIEW COMMITTEE 16. ATTORNEY-GENERAL 17. PURCHASE ORDER No . PURCHASE ORDER ISSUED


~ „ A **>45, l t

INSTRUCTIONS .

1 COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED2 CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8 ' -3 ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF ITEM. BE SURE TO GIVE QUANTITY DESIRED AND

ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES * J , *

DEPARTMENT FILE " :

PU R C H AS E T^dOlS ITI0 N

A.AM EH’ ~a'. SAMOA GOVERNMENTpago t American samoa, 96799

2. DEPARTMENT/',. - .*«\ ;K>‘ •'

Procurement Office .

3. TODAY’S DATE'/ ,' ', .'/>/ ;

“'April 8, 1988.

Y"', „ /------ ---------------T~-------■ ... •v—:- ■

REQUISITION ' ' • ; TftftTITNUMBER m^v-y. 1 UU | 3

4. pRIGINATOR^S NAM6;4.TELEPHONE.NUM8ER.;/> / *t > /-y

:v Mi Toleafoa5. DELIVER TO ^ * ■ . ■ * ,

Shipping $. Receiving

0. DATE WANTED ” * -v

ASAP :• • ’7. SUGGESTED VENOORy

i.-V, ■ A> .!> Vt iifcV

‘"AM

South San Francisco; Ca. 94080.

\ ;4r'-I-

8. REQUESTED METHOD OF.SHIPMENT

□i SURFACE' ' K1 * 1v □ AIRFREIGHT':;;.:. -

: □ SURFACE MAlirV '* '* - . — - > ...

AIR MAIL., \:X~\ '□ OTHER ' ' ' ' ■'


ITEMNo.

. /*'; PART No. AND/OR DESCRIPTION "VMODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED

QUANTITY OESIRED .

ESTIMATED ’ UNIT PRICE J

’ (IF KNOWN)


9. FOR PROCUREMENT ONLY.

1. Gas, Chlorine for refill and return to American Sanoa Government.. . .. . a.;.

Chlorine Serial No's: Listed. ,

30-cy. $78.40

1. ■ 6068307; ; i IS; 419964 -2. 41997S . 17. :165583.; 10824 -f/ 18. 419989,4. 6068301 19. 419973

419987 V y ;20. 10788,6. 6110918-’ - 211 419992 ..7/ 6068306 v : 22. , 108178. •■16515.; 23. 60683339. ■ 108131 ;//y 24. 419978-

10. 420000 r /A?: y 25; 420006:11. 419998' '/ r 26. 16555 : . ;12. 419980 27. 2050 =13. 16534 28. 611091ft;14. 10792 29. 6110946IS. .. 16561 30*, 6110948'

52352.0(

7 W' ffi

■■ •.. 'C^‘ ,',L

•K '• ;

xMifrxCU:WT: 2550;

122-

: lbs.ft.

n^rir V ESTIMATED SHIPPING CHARGES |tgg qq

K • TOTAL REQUEST .•K. 52,940.(0

^ SCREENING AND APPROVAL SIGNATURES ►

10. DIVISION APPROVAL 0-11.000':-;V’

11. DEPT.-APPROVAL S1.000-S10.000 • •

'• : BENM.TAU

Chief Procurement Officer

12."PROCUREMENT SCREENING'.

13. BUOGET APPROVAL 14. GOVERNOR APPROVAL •

PROCUREMENT OFFICE USE ONLY

15. PROCUREMENT REVIEW COMMITTEE - 16. ATTORNEY GENERAL

1~~‘ '' j'; ->■ . ' »<- < i- V' «

17. PURCHASE ORDER No. ...-

• V at '*'-'1 r18. PURCHASE ORDER ISSUEDVi.>. ft. .-.v. . J . . r'i’

/ ' ’ ‘


w‘ '-'ht

INSTRUCTIONS:"'1.' COMPLETE BLOCKS T THROUGH'7?AS INDICATED ,V- 2. CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8T ' '

, 3. ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION.OF ITEM: BE SURE TO GIVE QUANTITY DESIRED AND- t ESTIMATED UNIT AND TOTAL- PRICE IF KNOWN SHOW ESTIMATED SHIPPING"CHARGES:'^r.:-L".v‘--‘./; : i

f ■©S'

DEPARTMENT FILE

ASUFORM

,672 (REV. 7/71)PURCHASE REQUISITION

-• - '4 / ,&\V5V* I-

.1. ACCOUNT No. -

-“=-77530-5994;'2. DEPARTMENT..

General Supply. ORIGINATOR’S NAME & TELEPHONE NUMBER

^tTsuGGESTED VENDOR

3. TODAY’S DATE

’: AMERICAN SAMpA GOVERNMENTPAGO PAGO, AMEPr "N SAMOA, 96799

5. DELIVER-TO-^ UV K.Shipping &‘RBedLvi6g7- -;;v

joies 0B3#gCvTnc..

U ;Hilpitas,CA. 95035 :(403^262-8300)~

,£»., IKC. kji■ 1681^Grandview Drive

REQUISITIONNUMBER - 3 65434 A

6. DATE WANTED

8. REQUESTED METHOD OF SHIPMENT^',.).

XSX SURFACE ; A'.

□ ■ AIR FREIGHT

□ ■SURFACE.MAIL W/V ' □'AIRMAIL ■ f"i \y ‘□ -OTHER V' . ■

f. .t

IF AIR SHIPMENT GIVE JUSTIFICATION •

tiCr-T- ...

M

ITEM \ No. '.‘MODEL No

Soi^Sa^f<rdaftffiijab®To»CA.-.1.794080 . ;FMC#2274 »EL Na S SERIAL No.'OFJTEM FOR WHICH PARTS ARE ORDERED ; — .*■ “

.QUANTITY'OESIRED

-ESTIMATED ■ UNIT PRICE (IF KNOWN) •

TOTAL ESTI-. MATED PRICE. (IF KNOWN).. .


1. GaS. Chlorine, for refill and return to American Samoa Government.

2; -^S;'.Catbqn'.Diaad(le#' :£&,.reî1and return to ‘

60-cy.

30-cy.

Enpty Cfalorine Serial-flip*s. listed.

1. y42006 713,2. V419982 :14.3. 419966 15.■4. 419997 /---

,3. >419989 16.6. ‘ 419961 ■; 17.

^;7,:Bl6555:ii 18.8. 10814 7719.9, 17157^20 v

10. .420010 >21.11. >419976;i22.: 12. 419994 23.

420003419984;419975

16554 I.419976r10824v420013419963.41999816550420009

;. 24.1.430011 >25. >2449 r ;26. -10788 "27. ., 419990

, 28..:. ;-419963 ..29. :10791 .30. /419993

••/, 1 ‘"VKV\ ' 4-rl „ .

. CLJ: 244* v

; Kr:>;4,800-lbs.

$76.00

$40.00.

$4,560.

-5 “ '

$1,200;

X)

Kffe

'■ r.

A-

CANT'D.'

i. ' ) ‘ :•1

ESTIMATED SHIPPING CHARGES' $11440. >0 i■t:-

V .TOTAL REQUEST $7^200.00

10. OIVISION APPROVAL 0-S1.000

* V, SCREENING AND'ttPPROVALSIGtyATURES

11. DEPT. APPROVAL J1,0ix«10t00p ..

'•/: ’’A V- Chief Procnrprraht


v

13. BUDGET APPROVAL ; . \r

V,'

14. GOVERNOR APPROVAL *

; PROCUREMEnYoFFICE USE ONLY

15. BIDDING DATE MAILED 16. DATE BID AWARDED • 17; PURCHASE ORDER fy>

Vsfc®.’. • 'c,

18. PURCHASE ORDER ISSUED

19. SHIPPING INFORMATION-20. VENDOR .

if- ' .;.si• -•* L-..'. • y r A^-v. 7T-L<^ "*

' ' < v’ rl ; " 5- -21 T ^ /t ^ t 1' . , t < * i"-'-:

.-4

T ■ INSTRUCTIONS

.1. COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED- i‘?5i ' - .7 ; ’ ,V v2 CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8 , ' « -7 - "

.* v3..vALWAYS GIVF PART-NIJMRFR ANn/DD'RDitrr ncopDiDTir»M r\r- i-rr>< _ .r. ■■,3..

0 ruLfl/ nmi ,r‘: ’1,1 "-Our r / Mo/ilNUiUA I tLt

DEPARTMENT FILE

./BE SURE JOiGIVE QUANTITY DESIRED AND -7.* > HIPfr

/ •

SEV. 9/87)PURCHASE RF^jlSITION /,-? ? AMERICA' " AMOA GOVERNMENT

PAGO PAG .ERICAN SAMOA, 96799

1. ACCOUNT No.

7530-59942. DEPARTMENT • ,

Gffiee of Procurement3. TODAY’S DATE .'

February 9, 1988REQUISITION^

DUMBER 700124. ORIGINATOR’S NAME & TELEPHONE NUMBER

M. Toleafoa5. DELIVER TO r]1

Shipping 8:Receiving6. DATE WANTED • .

. A.S.A.P,7. SUGGESTED VENDOR ’

■ j • ** 1 • ,*' .'V ■ ‘1. . •" . -

David £. Lindemuth Co.' Inc., : 1681 Grandview Drive'', ,*South San Francisco,. Ca. . 94080

/ /

- .;v.

riON T

8.IREQUESTED METHOD OF SHIPMENT i

- □ -SURFACE ■ AIR1 FREIGHT * -

□ SURFACE MAIL '

□ AIRMAIL .•'□'OTHER , - ‘

~/u

fj


ITEMNO,

- \ * PART No. AND/OR DESCRIPTIONMODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED ’

QUANTITY DESIRED ’v'

ESTIMATED UNIT PRICE {IF KNOWN)

TOTAL ESTI-. MATED PRICE (IF KNOWN)


1. Gas, Chlorine for refill and return to American Samoa Government. J., „ ilSS-cy.

Chlorine Serial No^s ; Listed. , V V. -

1. 420002 819995 11. .4199852. 16551 7. 419963 12. ,4200093. 6110951 • '*■ 8. - 420017 13. .. ,4199824. 6068323 9. 6068304 ,14. ...4199905. ^ 419961 10. 6110925 . 15. , 419996

$78.40 11,176.00

ESTIMATED SHIPPING CHARGES------- :̂ ■ 1294400

TOTAL REQUEST,470.00

SCREENING AND APPROVAL SIGNATURES.••J5

'Hi10. DIVISION APPROVAL 0-S1,000 11, DEPT.JAPPROVAL $1,000410,000.* \ : . ,

BEN M. TAU / Chief Procurement Officer

12.;PROCUREMENT SCREENING

13. BUDGET APPROVAL 14. GOVERNOR APPROVAL-

^PROCUREMENT OFFICE USE ONLY ,

15. PROCUREMENT REVIEW COMMITTEE 16. ATTORNEY GENERAL 17.;PURCHASE-ORDER No.

yn

18. PURCHASE ORDER ISSUED :

19. SHIPPING INFORMATIONA' ^ , V' - :>

\ , ^ - „V*r ** *W

^1; COMPLETE BLOCKSt THROUGH .7 AS INDICATED.^2l CHECK REQUESTED METHOD OF’SHIPMENT IN BLOCK 8.

' 3. ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF ITEM. BE SURE TO'GIVE'QUANTITY'DESIRED AND - ... • .ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES. ®s

DEPARTMENT FILE

/n? ,, .v- .a;--'..-..* -;n - • ->;r-•

/v ?osrgm ; PURCHAS'" REQ ^SITION " " ~ ^

iCCOUNT.No.'t .-v

■ >. (». ' ,V.;^ 17530-5994-

TICAN .' 1A GOVERNMENTPAGO, A. JAN SAMOA, 96799

2. DEPARTMENT,

Procurement OfficeXX *j' \ $? M- .7. 3..TODAV;S<OATE;'>.,^,<’^^.: •/.-

Sept. 27, 1988.„:.

•av.REOUISmON/t'.Jf’" /NUMBER' ' ■•- - *' •

- »--* 1 *A ..-..'pT ^ 85238'4. ORIGINATOR'S NAME A TELEPHONE NUMBER*--,//

M£ Toleafoars

5. DELIVER.TO * *« >,

Shippifagi §,. Receiving. DATE WANTED-

ASAP,7, SUGGESTED VENOOR-;.,'

Day id; K.Lindeauth, Co. Inci ^7

South San Hfancisco, Ca. 94080

5- rf

i**?'

' t*.T ■} e-5;

.•>REQUESTEDJMETHOD OF SHIPMENT^ ■ < -S $Xi-

' □‘surface

■'-'□-AIR FREIGHT;'- ’. =e"\\7“ !-

□ SURFACE MAIL’□ ■AIRMAIL - ' ' :

' □.OTHER

IF AIR SHIPMENTrGIVE JUSTIFICATION;

ITEM- PART No. AND/OR DESCRIPTION ' 4 - ’“QUANTITY ' ESTIMATED . TOTAL ESTI- 9. FOR PROCUREMENT ONLY

Na . , MODEL No. & SERIAL No. OF ITEM FOR WHICH PARTS ARE ORDERED^ »'■ 4 ';bESiRED:; ‘ (IF. KNOWN)- *• / (IF KNOWN)f • ‘rPR»CE 7 * '7' TOTAL ' A '

1. Emptji Chlorine Gas , for refill and return*. . . • ' . 7

to American;Samoa, Government . >-v 30-cy. $78.40 ^2,352.1

Chlorine Serial No's; Listed. '. ‘ ’- : ' - ’ . p ----- t . _ V

ri 419961 J=tl6L <3116.C-':/' t . .

•; _r • • 1 vC '*

- '' ’ii •'' r ■V 'V -

2V/ 10810 V;: 11. 419977 . ..... v&\' ‘ ‘A’ •; f ••

3l-/ 419966 , 18. 419974 -a . 1 f y "• ■ u . ;l ■" • ’ •

4. 419979. - 19.; 10802 ... . VjT'p.L. ^ V V;5. 419996 20. 419967 , . v ><_■. r '•/.• .-V :6. 419962; . 21./ 6068326- : ' .7. 6110962 22. ,419976 rJ/, x. V-'.V ' . :-7'^;'7v ‘ ;; 7.yv.

8. 419990 23. 420007... . , ' / 7, •■; -

9. ,10780 24. • 419997.'. '10. . 41998S : . 25. 6068298:.' X 7V''r /.y-

Ill 1373 26.- 2217 ■ :J 77m7^; ‘7 ■.■''■7 r\ ■■■

12. 120013 ' 27. 41996513. 10806V ’ 28. ; 6068329' / : ,r‘' '' V -• *14. 10808 29. 41997015. 10320 30. 420001 L r™/' 777^ ' 7 /7-/ ■■ ;v-'-

^ T _

ESTIMATED SHIPPING CHARGES ‘588.00

- J--" !.

. - f t p- , 1 r.

k.v- ; TOTAL REQUEST ; 2;940.0 ’ 1 ■ • ' .

SCREENING AND APPROVAL SIGNATURES'?

10. DIVISION APPROVAL 0-S1,0004 11. OEPT. APPROVAL $1.000-$10 000 -'^. ; *

LA»AU M. SEUIActing, Chief Procurement Officer


13. BUOGET APPROVAL 14. GOVERNOR APPROVAL


,15. PROCUREMENT REVIEW COMMITTEE-*’ r*J'‘ 16. ATTORNEY GENERALHî;***<■/ ' *V, . At "

17i;PURCHASE.OROER

( tC'f ?- st

18: PURCHASE ORDER.1§SUED _


>/r_ :■? -frl T'rfc.T3~

1 COMPLETE BLOCKSiTHROUGH 7 AS INDICATED/ --P-" - ' J ‘

?' 2: ’CHECK REQUESTED'METHOD OF SHIPMENT IN BLOCK 8.J V- tv"-1 ...... . Ji- .,3! ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTIONOF ITEM. BE SURE TO GIVE QUANTITY DESIRED AND

ESTIMATED UNIT AND,TOTAL.PRICE;IF; KNOWN SHOW ESTIMATED SHIPPjNG^CHARGES:; >r; ^ ;:-;; _.,t

INSTRUCTIONS

' DEPARTMENT FILE . ^■®s-'

r.>

ASGFORM

PURCHASE

• 1. ACCgU

7530-5994

ft.' v V ‘ : c-s-aTf ~ ’ :PAS0p<7\)MERIAMERICAN SAMOA GOVERNMENT

' . 4PAG0 PA,-V AMERICAN SAMOA, 96799

2JDEPAmMENTgrJj'v.!i%^,r,,Ji.«-;j i;.TOOAY'S DATE>;Office of • Frocuremei it:W' flebruary 3, 1989

REQUISITIONS NUMBER -: : I

85387

^“Vs

4. ORIGINATOR’S NAME & TELEPHONE NUMBER

;, M. Toleafoa •

5. OEUVER-TO^-

Shipping & Receiving •< ' ■-£' ;*

>: DATE WANTED -

ASAP

‘ L‘

■ 7. SUGGESTED VENDOR- “• ' ■»'<,» j . , ...•* k ‘ - %•• /■ : - ^ ...' ■-•< ‘.H ■

W David, K. .hindemuth ~ a's- ft; *'^''1681^ Grandview?Drive’ ,,v -'.i 1 ^ **’ *■. South San Francisco/ Ca. . 94080 ;

V„v-•Trr-.r» - ?\f(/~ .v!;/ V-h. ®* TS

I ^ i;

a REQUESTED METHOD OF SHIPMENT*4; '-v

□ SURFACE , ,'tvm:/ . > ‘ LOfew At*’

LJ OUHhÛt/.. . \x *, J A V;'-.-;.V,

'□-SURFACfMAI^P-:^^/'" 7 //.

AIRMAIL- - -vV A - -□other "

IF AIR. SHIPMENT GIVE JUSTIFICATION-'

ITEM ’ / PART. No.’AND/OR DESCRIPTION'^-''x •V* \..QUANTITY- ;'/ESTIMATED; ' , TOTAL ESTI--. 9. FOR PROCUREMENT ONLY - ; •/ ■' • ■ '

No. • MODEL No. & SERIAL NoZ-OF ITEM FOR WHICH PARTS ARE ORDERED/, :-J DESIRED;. , V.(IF'KNOWN) (IF KNOWN)'.1 , PRICE. TOTAL • - * . ’

1. ' ■ ,?.V - - ■Empty Chiorine Gas* for refill and return'?y -

to American Samoa Government • 30-cy. $78,40 -2,352.0 ) - , ■ - \- V. - . n,;- *■ w * . ^ -V. -*

Chlorine Serial No1a S Listed. -V .

’ -lV. r" - T**':1. -3.6538;^- 16.. 107831 r ( i

•i v 2, : 420018 - 17. 419991 ~ & • ■ ■ ■- - • ;3. ,16545 ft; 18. 1784 t

~r-. ■ -4. 16532 19.~ 6068301 V ' . , ., 1.1 • ‘ • . ' v„ ■ p;/

v?L. A '■5. C16530 20. 10814. -1. . V -v

>■’ ■ ;6. 16558 21. : 16523 * - . ■ , - , "■[' _ 1. it ~“.i ‘or. 1 >• •- ' • r \\ ■•;A L/V i7. 2237 -22. 420016 r ;:.v' •8* 10824 23. 419980 - : . Vi'’.•' • . ( ■ t ’ .9. 420011 24. 6110948. -■-'I' ; /:r < ■ 'C j ' : ' • v J.vv--v -4" ' .. V" ' . -

io. 10792 25. 13121 V ' , \}J'Y •’ ' f:

n. 16557 , 26. 419972 V", -> :F-%:: ■' ;'vv\f' v. \V!12. 6068299 27. 16514 " - . -13: 420010 : ; 28. 16550 . •- : -V-. : - . ' ...14. 10823 29. 42000215. 1763 30. 7728

V -

• ' 1*-.^ »■•' ' ;v, V A 1 ~ 'K«

+.1- ■ r >.■ i ■■■-.

• >•-» ’ ,•ESTIMATED SHIPPING CHARGES " $588.00 7"- i- ;//'

■ ''-f

f-

^ J TOTAL REQUEST $2,940.1 )0.1- FU'' , r

t.., \.:ry.\ SCREENING AND APPROVAL SIGNATUREStr'

■ --10. DIVISION APPROVAL 0-S1.000.

H.A. Lelauti

11. 0Ef>T-. APPROVAL SI.OOO-JIO.OOO^- ^V^ ■ V

— PAUL FELISE ; Chief Procurement Officer

12. PROCUREMENT SCREENING-.

13. BUDGET APPROVAL . 14. GOVERNOR APPROVAL


15^ PROCUREMENT. REVjEW. COMMITTEE^Vl-' I6> ATTORNEY GENERAL'.'*

'■%YF

17: PURCHASE ORDER No:/--' 10..PURCHASE ORDER ISSUED .


r;.,' -.'

- '' i.'COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED.' T - □’"'A;; -YrY V-

■::Y ' 2. CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8.>- ; . ’ '' , : - v;-. 'i 3. ALWAYS GIVE'PART NUMBER AND/OR BRIEF-DESCRIPTION OF. ITEM. BE SURE TO GIVE QUANTITY DESIRED AND V - •V‘ ; ESTIMATED UNIT AND TOTAL PRICE IF KNOWN SHOW ESTIMATED SHIPPING CHARGES.> - :- t ■ i

i INSTRUCTIONS

DEPARTMENT FILE

ft;—PURCHASE REp\ISITION ‘

gU\ WT(REV-9/87) r ‘ \ Jc'AMERICAN .’10A GOVERNMENTPAGO PAGO; IlCAN SAMOA, 96799:

Stef-

ft.

■sSfei

Vff T -ACCOUNT No.t.-. - •)

7530-59«42 DEPARTMENT'^,'-, ^

Office of Procurement3 TODAY’S DATE, ‘ t* 7, 7 *

November: 29*^ 1988:REQUISITION -

NUMBER

85286

\ 4 ORIGINATOR’S NAME& TELEPHONE,NUMBER-'-.f4.5

M*.; Toleafoa5.’ DELIVER.TO.v

Shippings Receiving, DATE WANTED.-.*

ASAP X"...\ ■ i'

. 7; SUGGESTED VENDOR. -** • .• V -$*

David. S. UademittCo *iyintgkr, • - 1681 Grandview Drive' \South San Francisco, ,Ca.; 94080

S REQUESTED METHOD OP SHIPMENT; .

.□ SURFACE /.*V * , t Mr's!.. ••»/».•*> •,«''□ ’AIR-FREIGH^;rr;,;y

□ SURFACE MAlL -’

□ AIRMAIL□ OTHER-

V,’ ••..-•■V'r'i A.’-’a-s.s, . 'Vi. .....

IF AIR SHIPMENT GIVE JUSTIFICATION "

V ^

* ’&

ITEM. No. •*'

‘ -PART-No. AND/OR DESCRIPTION’;\ MODEL No. VSERIAL.No. OF ITEM FOR WHICH PARJS ARE ORDERED-: / ♦*’ v.’*'

QUANTITY;.;:, .OESIREO - V:

. ESTIMATED - UNIT PRICE

- (IF. KNOWN) '

TOTAL ESTIMATED PRICE. (IF KNOWN)

9. FOR PROCUREMENT ONLY. ,

IT

2.Emptji Chlorine Gas* for refill and return, to American Samoa Government.;

Empty Carbon- Dioxide; Gas* for: ref111 and return to American Samoa Government. -

--•/.:;-v r’^4V-/ "yv/' / . ::■£/•■' vChlorine Serial No's: Listed. 11. 420006 r ; 11. 6110947 21. 60683362. 420008 12* 6il0956 22* 60683373. 10819 : 13. 419971.-1 23. 61109654. 6068324. 14. 5110945, r 24; \ 107935 ’J: 419981 15. ,6110853 • 35. 60633176. 420017 16. 420004 . 26. 107887. 10809 . 17.; 6068318 ;/27-V-'. 4i99998. 10815 18. 10790 “'■ 28; - 4199689. 3260 19.; 16068336 29. 10804 :10. 6110925 20. 17223

• -- r30. 1827

K1PTY CARBON DIOXIDE SERIAL No*S; Listed*

30-cy.

15-cy.

$78.40 12,352.00

$ 40.00 600. CO

1. 4690 6. 4596 ,11. 3988.

2. 4761 7. 2904/ 12* > 46063. 4933 8. 2920 13. 47934. 4855 s 9. 395t? 14* 48165. 131— 10. 3981

ESTIMATED SHIPPING CHARGES' ‘ 738.00

15. 4660 TOTAL REQUEST^; 8,ô)

SCREENING’AND APPROVAL-SIGNATURES-'

10. DIVISION APPROVAL 041.000 11. DEPT. APPROVAL JI.OOO-SIO.pOO-1' : 12: PROCUREMENT SCREENING. '

BEN M. TAB '..........Chief Procurement Officer


PROCUREMENT OFFICE USE ONLY - , •

.1S. PROCUREMENT. REVIEW COMMITTEE**.^^ , «• -y ’fk

* - / - - ^ J. i>-

16.--ATTORNEY GENERAL-: 13J. PURCHASE ORpER 18. PURCHASE ORDER ISSUED;./.';-V.'

19. SHIPPING INFORMATION 20. VENDOR

r \ t *

_Liy

- v - . INSTRUCTIONS- _ ,• •.-.-’r* ' • .' -c i-j.- •• -'i! 1 .-■i.-. t'.x.. ■*? ~ --^-4' ' .:-v ■.* • m ■ -- ••-'■s?'-..'" - J ■ •. — . ‘" -.-. .. ’1 . ' « - .- > • V C-J-'V •• • .*' V ' • " r~ yi J ‘ -V'.I • . - ,'v . '•* >, >: _ 1 .V;.' - r- t„v'

1' COMPLETE BLOCKS 1 THROUGH 7 AS INDICATED. ' " . " ; .

2: CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8. * /- • -3 ALWAYS GIVE PART NUMBER AND/OR BRIEF DESCRIPTION OF ITEM; BE SURE TO GIVE QUANTITY DESIRED AND

ESTIMATED UNIT’ AND,'TOTAL-PRICE IF.KNOVVN SHOW. ESTIMATED SHIPPING CHARGES.

DEPARTMENT FILE , / v v'./. ' •

<Bi ■

ASGFORM

f.'-JJiVjj > ; : " ... ' J VMS'- ; I'-'1 iir.i' '■ '"■ — ‘ ‘.

PURCHAF^RkUISITION ~>u>4 -'\«1E RICAN SAMOA, 96799 . '

ffTW). £•?*.' 5.A-'

.yf-x.kk 'k-vkkkIrk'--1: ~> -7«;’0-SQ94

-XY''\ -

V-V

:$r/- t‘>-

-j:’ 3 k

' -.4. ORIGINATOR'S NAME & TELEPHONE NUMBER;-- ^ .,•■;* •

■4W'''MV. TÎeafofe^^l':

2. DEPARTMENTS'-^:*’'**v

Office of Procureaejnt June?27, 19835. DELIVER'TO, .

^.TODAY'S DATE-'-

Shipping 8? Receiving

REQUISITION;.-;NUMBER^';

.V, •■% - vr’Vi*’.'. -kV/-.kV,.-- ^ ••

701626. DATE WANTED^.

ASAP '

7 SUGGESTED VENDOR ^ ?

'lOS^Grimdvi^^prive^'' - pr.South: Saii rFrancisco, Caw» . 94080

8 REQUESTED METHOD OF SHIPMENT J*, iS*

. □ surface . . k

^[XaIR FREIGHT - ,V ^

?□ JiURFACE'MAVL' k ■ - " »; □ AlRMAIL^V^^' ■ ' k • ■•■:•• Q OTHER ' " **■*;■* v : ‘ '•’


l ,«•

ITEMNoT“*

!k-

. . PART No. AND/OR DESCRIPTlON-r • • - .<« ‘ MODEL: No. 4 SERIAL No. OF ITEM: FOR WHICH PARTS ARE.ORDEREO.

Empty ailorinor^s^^fwlrefill^^ return

to American Samoa Government/. . ....

- t: i'i.-21.. * < : j.T— C&Lt-Js' ■,

Empty Carbon Dioxide Gas, for refill and •;

return0 to American Samoa Government-

j-.v ’■ .£< .,.):77q. : ,;V - - Si"‘ 4 ** t c * *"* .(C-» *; Chlorine^SeriaAl No's; Listed.I: l.: 6110921 14.i. ; 169504 a12& 606832S is.: o6110917 28i- 10791

3.V. 6110957 16.] 6068297 29. 10794..:: 4. 61109S9 i7. 6110928' 30.. 10736■ • 5y 6110931 ; /' - 18 » ^ -6068309

6. 2440 . 19 k 10019 :v; ■;■:■■ v',7. 1715 f 20.- - 10796k. ' '.kj-fk-vk

■ 8.- 611095. 21. 10825 “ - t.’ ..-.-X,.r 9.. 419969 22. 611094110. 1082 23. 420012Ill 419986 24. 419993

—- ■' j1 .

12. 419988 25. 419983 CU; 122V13. 420Q03 . :: y- 26k !10782 . ...WT: 2550-

QUANTITYOESIRED

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-Its.

ESTIMATED UNIT PRICE

' (IF KNOWN)

$78.40r ••- :•j.. ■ ■.

i -4- ■■ -$40.00

$2,352.00

Jl, 000.(0


ESTIMATED SHIPPINGiCHARGES$858.00

9. FOR PROCUREMENT-ONLY

CONI'D.

TOTAL REQUEST$4,190.00

SCREENING AND APPROVAL SIGNATURES*.

10. DIVISION APPROVAL‘0-41.000 11. DEPT. APPROVAL $1,000$1p,000 k-. .J k k'

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BEN:tfs-.TAU■'*•**-~Chief PT-orirrement flffirer-

v' 7 y..- 14. GOVERNOR APPROVAL

12. PROCUREMENT SCREENING ' / ■&

13. BUOGET APPROVAL

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' PROCUREMENT OFFICE USE ONLY

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15.- PROCUREMENT'REVIEW COMMITTEE.-.Ik

—-vww.-iJvS*- '-r-X5. -V&k • L'' cpy '■

17: PURCHASE ORDER No.;:-- - ' ‘

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18. PURCHASE ORDER ISSUED

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_________ y

P CHECK REQUESTED METHOD OF SHIPMENT IN BLOCK 8.V? - 3; ALWAy.S'GiyEiPABT NUMBER AND/OR BRIEF DESCRIPTION OF ITEM: BE SURE TO GIVE-QUANTIJY DESIRED AND-

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"DEPARTMENfrar*:>^‘'>tS^!!'fe‘^''':- *■

Documents

ASG FORM ; PURCHASF‘ ASG^.- FORM 672 (REV. 7(71) ^ TSfiEour^a /PURCHASE REQrSITION AMERICAN SA' ^A GOVERNMENT PAGO PAGO, A^, .N SAMOA, 96799 2- DEPARTMENT 3. TODAY’S DATE 7530-5994