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VIEWS: 2 PAGES: 1

									PROGRAM NUMBER           PRINT ORDER NUMBER      JACKET NUMBER            DEPT. REQ. NUMBER



CONTRACTOR




    NON-COMPLIANCE                 GOV’T DELAY-WHAT WAS DELAY, NUMBER OF DAYS-DESCRIBE BELOW

                        DUE DATE                 ADJUSTED (GPO ONLY)      ACTUAL DATE RECEIVED
    DELIVERY                                                                  (Attach Receipts)


                                 COPIES SHORT         MISSING MATERIALS
    SHORTAGE

SPECIFICATION NON-COMPLIANCE/GOV’T DELAY




AGENCY           TELEPHONE NO.   SIGNATURE                                       DATE



NON-COMPLIANCE/CHANGE REPORT                                                   GPO Form 907 (R 10-90)

                                                                       GPO : 1996 0 - 170-056 17

								
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