a024 DISTRIBUTED a/0al25tonnarg FORM FIN1510-01 For Accounts Payable Use Only Vendor Number 52706 RECEIVED JAN 07 2U25 BY: SS CHECK REQUEST FORM Uset thisf form to arrange for payment tol individuals or! businesses whena al Purchase Order or P-card isr not required. This form must be submitted int typedi format only. Vendor. Information Date Vendor or Employee Name Sterling Water Technologles LLC 1/7/2025 Wtop Resolerglo fpaymentis toavendor isa Wgon emther Purchasing Office? fNo,a ODpWSMUSTDE attached Email Adriennes ME Brown inour Purchasing! Division, AnenneMgrownerecalecounvaros Mailing Address PO Box 830531 Philadelpha PA: 19182 Email Address EXPENSE/ACCOUNT DETAILS Date of Service or Invoice 12/16/2024 505 Description (for individuals, Services, Expense Reimbursements) Polyblend Orthophosphate Bulk Invoice# 15659 General Ledger Account Fund Function Account Dept. Amount $44,197.82 4430 531100 44 Total Check Amount $44,197.82 DESCRIBE FULLY THE NATURE OF THE PAYMENT Polyblend Orthophosphate 1 Ib Bulk 44.880.0000/b Please Refer to Tina Malone Dept. Designee L Staff Accguntant Date UbBa Date 1/7/2025 Directgr of Finance Date Date 1-474 Muenulk lyaif V22/202 Purchasing talas wabu CHECK HANDEING INSTRUCTIONS GRIKUPApproVa! by Finance Director pme every Friday 5.Mall envelope) 7.Send Inter-Department Mail (Enclose attachmentsifr required in! letter size Avallable att the Finance Office Front Desk after 2:00 Will bep placedi in mallbox after: 2:00p.me everyFriday NV.as ay Please send this form with attachments to thel Department of Finance. Each'çheck request received Monday-Friday willl be processed the following Friday. 20-42 INVOICE Date Invoice# 12/16/2024 15659 Date Shipped, Order# 12/16/2024 15790 Sterling Water Technologies LLC P.O. Box 602 Columbia, TN 38402-0602 (931)540-1334 FAX(931)540-1338 Customer Number: 9ROC10 Rockdale County 3090 Gees Mill Road Conyers,GA30013- Rockdale County 3090 Gees Mill Road NE Conyers,GA30013- T o o Customer PO# 122158 Requlsltion# FOBF Remark Delivered Freight Torms 3rdPartyFreight Terms 1%10Net30 Product Name CP723L CP723L-BULK Lot:STE18-MG-2406 Duel Date 01/15/2025 Ship Via KAG Sales ID 9CH Amount 44,197.82 /b Units Package 44,880.04 1bBULK Total Quantity] Unit Price! 44.880.0000/b 0.9848 NEWI REMITTANCE EFFECTIVE MARCH 11, 2024 ACH/WIRE: Bank Name: PNCE Bank Account Name: Sterling' Water Technologies Account Number: 8521938156 ACH Routing Number: 031000053 Wire Routing Number: 043000096 Wire Swift Code: PNCCUS33 CHECKS: Sterling' Water Technologies PO Box 830531 Philadelphia, PA 19182-0531 Please Remit To: Sterling Water Technologies 44,197.82 Page 1of1 P.O. Box 830531 Philadelphia, PA 19182-0531 Total: Thank youf fory your order. Payments are duel In U.S. Dollars. Straight Bill of Lading Short Form Original Not Negotiable B/LI DATE 12/10/2024 B/LNO. 15,790 Page 1of1 Sterling Waterlechnologles P.O. Box 602 Columbla, TN 38402-0602 (931)540-1334 Fax-(931)540-1338 Sterling Water lechnologies I P clo E&C Chemicals, Inc. F 220 Avenue C R Carrollton, GA 30117 CUST.NO. 9ROC10 SHIP. DATE WAREHOUSE 12/16/2024 QUANTITY QUANTITY PACKAGING ORDERED 45,000 Rockdale County 3090 Gees MilF Road Conyers, GA30013 Rockdale County 3090 Gees Mill Road NE Conyers, GA30013- Phone-> (770):2 278-7484 Tim Check 0 SALES AGENT 9CH STE18 OPEN 45,000 1.00lb BULK OPERATOR brobinson FREIGHT 3rdParlyF Freight HM DESCRIPTION NOT REGULATED CP723L CP723L-BULK Line Item! Remarks: NSFIANS! STD 60N MUL:29.0mgL General Remarks: BULKE DELIVERY HOURSO 0800-1700MON-FRI REQ.NO. SHIPV VIA Truck FOBF REMARK Dellvered PON NUMBER 122158 NET 45,000.00 CUST ORDERI NUMBER 15790 DÉLIVERY DATE DELIVERY TYPE 12/16/2024 Regular WR GROSS FRT WEIGHT (ib) WEIGHT (lb) CLASS 45,000.00 60 FORCHEMICAL EMERGENCY. Sei,Lak.orAcident Call Chemtrec 800-424-9300 ACCT#9357 SEAL :4 4793, 4814 NSF Cerliedio NSFIANSUCANBL CARRIER SHIPPER CERTIFICATION This is tocerify that the above-named materlals are properly classifed, described, packaged, marked and! labeled, and arei in proper condition fort transportation accordingt to the applicable regulations.oft thel Departmento of Transportation. CONSIGNEE SIGNATURE OF ACCEPTANCE (2-16-2 Del KAG CARRIER Placards Offered (driver initiais) Carrier Signature of Acceptance Date: QUOTE# KAG PA DATE FREIGHT TO BE PPD/3RD PARTYI BILL TO: 3