DEP Memorandum on Federal Reimbursement Documentation, September 18, 2001

RENTED EQUIPMENT RECORD for (applicant)

Location of Work: Page of Description of Work: Period: to_______ 19

FEMA - DR-NY D3R# Category of Work: A B C D E F G (circle one) LI Type of Equipment aI Date & Rate per Hour ±1 Invoice ADate aI Check Total Vendor Indicate make, model, size, capacity and horsepower as appropriate. Hours Used w/Opsralot wo/Operator Cost Number Paid Number

c <D E 3 o o Q TO CM •c ID CM o Q_ o o Z Total Cost o (this page) o 3 0. o'

§ •I certify that the above information was transcribed from daily logs, vendor invoices, or other documents wiTich are available for audit. I Id o “Certified By: Title: Date: z z RwriiSEMO 14: 7/94 (appiovof, toT local rrproductlon)