HomeMy WebLinkAboutNew Report of Loss Form - Fallout Shelter Supplies DEPARTMENT OF THE ARMY
OFFICE OF THE SECRETARY OF THE ARMY
OFFICE OF CIVIL DEFENSE
REPORT OF LOSS - FALLOUT SHELTER SUPPLIES
1. TO: 2. FROM
Commander
Defense General Supply Center
ATTN: Civil Defense Branch
Richmond, Virginia 23219
3a. FOR SHELTER NUMBER b. STANDARD LOCATION c. ORIGINAL VOUCHER NO. (If available)
d. LOCATION e. STOCKED SPACES
It is requested that your records be adjusted, as the following items of supplies are no longer available, or
suitable, for shelter stocking purposes for the reasons shown below:
ITEM QUANTITY ITEM QUANTITY
Medical Kit "A" ea. Biscuits lbs.
Medical Kit "C" ea. Crackers lbs.
Sanitation Kit III ea. Bulgur lbs.
Sanitation Kit IV ea. Carbohydrate Supplement lbs.
Shelter Radiation Kit ea. Ventilation Kit "A" Unit ea.
Drum, Metal, Water Storage ea. Ventilation Kit "B" Unit ea.
Ba Liner, Polyethylene ea. Individual Components (List on reverse side)
from Kits
REASON
MAJOR NATURAL DISASTER (Federally declared) 1 !NATURAL DISASTER I 1 FIRE 1 1 EXPLOSION
1 FLOOD f VANDALISM 1 1 THEFT 1 1 OTHER (Specify)
GIVE DETAILS OF INCIDENT GIVING RISE TO LOSS AND INDICATE CORRECTIVE ACTION TAKEN WHERE APPROPRIATE• (If necessary,
use reverse of form)
I CERTIFY, ON BEHALF OF THE POLITICAL SUBDIVISION WHICH I REPRESENT, THAT THE INFORMATION CONTAINED
HEREIN IS, TO THE BEST OF MY KNOWLEDGE, CORRECT.
TYPED OR PRINTED NAME AND TITLE SIGNATURE DATE
OCD Form 514, May 67 REPLACES OCD FORM 514, NOV 64, WHICH MAY NOT BE USED.