ZBIORCZE RW NR. 108/15
NAZWA TRANSPORTU (numer rej.) OPEL MOVANO WOT 16348
RODZAJ PALIWA (EKO/PB 95 / ON) (Niepotrzebne skreślić)
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Lp. |
Nazwisko Imię pobierającego |
Data |
Godzina |
Stan licznika |
Ilość pobrana |
Podpis pobierającego |
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Razem litrów |
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Sporządził (data, podpis) ……………………… Rozliczył (data, podpis) …………………………