Attach 3 FP20E.pdf
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- W9124E20B0001
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SECTION III - VALIDATION OF SERVICES
SIGNATURE
Start: End:
Delivery Location:
FROM (Organization):
Number of Personnel Supported:
Number of Latrines Required:
Order Number:
SECTION II - APPROVAL
CONTRACTOR NOTIFIED: (Date/Time, Signature) NOTIFIED BY: (DPTMS Representative)
Signature of Requestor (CO or S4 Officer):
Pickup (Specify date/time):
2 Day Intervals
Relocation (If applicable) Specify date/time and location:
Other (Specify):
APC (Fund Code): Point of Contact Name/Telephone Number:
DATE SERVICE PROVIDED
(Delivery, Service, Relocation or Pick-up)
QUANTITY PRINTED NAME
REQUEST FOR PORTABLE CHEMICAL LATRINES AND VALIDATION OF SERVICES
(The proponent of this form is DPTMS, Range Division)
SECTION I - REQUEST
SECTION IV - SUMMARY OF CHARGES
SERVICE
DELIVERY
SERVICE
RELOCATION
GRAND TOTAL:
PICK-UP
FP FORM 20-E (Revised), 1 MAR 2008
The information listed below will be used to compute charges for chemical latrine services. Government representatives must verify information provided is true and correct by printing his/her name and signing in the space provided.
TO: DPTMS, Range Division ATTN: Chemical Latrine Contractor Fort Polk, LA 71459
Dates Required:
Required Service Frequency:
(For use of this form, see JRTC & FP Reg 350-2)
Special Requirements:
CLIN QUANTITY UNIT PRICE TOTAL CHARGE
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