PROGRAM NUMBER
PRINT ORDER NUMBER JACKET NUMBER
DEPT. REQ. NUMBER
CONTRACTOR
NON-COMPLIANCE
GOV’T
DELAY-WHAT WAS DELAY, NUMBER OF DAYS-DESCRIBE BELOW
DELIVERY
DUE DATE ADJUSTED (GPO
ONLY)
ACTUAL DATE RECEIVED
(Attach Receipts)
SHORTAGE
COPIES SHORT
MISSING MATERIALS
SPECIFICATION
NON-COMPLIANCE/GOV’T
DELAY
AGENCY TELEPHONE N O . SIGNATURE
DATE
NON-COMPLIANCE/CHANGE REPORT GPO Form 9
07
(R
10-90)
GPO
:
1996 0
-
170-056
170-056
INTERNAL
CARTON
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