Republic of the Philippines Republic of the Philippines
PROVINCE OF CAGAYAN PROVINCE OF CAGAYAN
Tuguegarao City Tuguegarao City
OFFICE OF THE PROVINCIAL ADMINISTRATOR OFFICE OF THE PROVINCIAL ADMINISTRATOR
GAS SLIP GAS SLIP
Control No.:_______________ Date:_______________ Control No.:_______________ Date:_______________
Service Station: PETROMAR TRADE Service Station: PETROMAR TRADE
Address: BONIFACIO ST., TUGUEGARAO CITY Address: BONIFACIO ST., TUGUEGARAO CITY
Please issue the following item(s): Please issue the following item(s):
Description Qty Unit Description Qty Unit
Special Gasoline Special Gasoline
Regular Gasoline Regular Gasoline
Diesel Gasoline Diesel Gasoline
Oil and Other Lubricants Oil and Other Lubricants
Signature over printed name of the driver Signature over printed name of the driver
Plate No. Plate No.
Approved: Approved:
EDNA T. JUNIO EDNA T. JUNIO
Provincial Administrtor Provincial Administrtor