|  | Stationary Shredding Note
--- | --- | ---

| Print Date | 10-OCT-2022
| Shredding Date | 10-OCT-2022

Reference: | REC-0000001 |
Remedy #: | REM- |
Remedy Date: | 2022-10-20 |

Sr# | Product | Serial/Part # | Unit | Qty
--- | --- | --- | --- | ---

Please acknowledge receipt by dating and signing copy of this form
Prepared By |  | Receiver Signature

Remarks Here

Prepared by |  |  |  | Date Time |