8. PREFERENCE RATINGS (assigned to chlorine requested) AND Uses.—See definitions on back of Instruction Sheet for PD-i90.
List below preference ratings assigned to uses by Amendment No. 1 to General Preference Order M-19 or otherwise, and
item numbers for each use. Show the amount of chlorine required for each use. The total of all such chlorine should
be the same as the quantity requested. (Pulp and paper producers requiring chlorine must file PD-190A in addition to

 

 

 

 

 

 

 

PD-190).
DEFENSE ORDERS—ALL “A? RATINGS
LEAVE BLANK
Use— PREFER- QUANTITY ESTiMaTED ESTIMATED
TTem ENCE OF ULATION SCHEDULED OPM Waeay: DURATION
No. RATING CHLORINE Orpery Sees ems ADJUSTMENT SCHEDULE OF oe
(1) (2) (Tons) (Days) (Tons) (Tons) (Tons) (Days)
‘
}
TOTAL FOR
DSPENeE ORDERS..21. es x x ox xxxx

 

 

 

 

 

 

 

CIVILIAN ORDERS—ALL “B” RATINGS

 

bn | 180 Ib. Cyl, 2 yee

 

 

 

 

 

 

 

 

 

TOTAL FOR |
CiViETAN Onpmrs jo XExXe = xxxx
|
GRAND TOTAL
FOR ALL ORDERS..-.. __ ABO Te eS Keke ak | xxxx

 

 

 

 

9. Additional revelant i eo licant may wish to present: _-.._.__.---__----___. st cleo ee
lisoded for thivers\ty aiming pool éhiorination ,

 

The undersigned certifies to the supplier and to the Office of Production Management that:

1. He executed this certificate on behalf of and by authority of
the purchaser of the above chlorine. (This item is to be filled in only if purchaser is other than individual.)

2. He has read and is familiar with the provisions of General Preference Order M-19 and Amendment No. 1 to it.

 

8. The facts set forth herein are true and correct.
4, The chlorine to be delivered on this order will not be used for other than the purposes specified above.

5. The chlorine to be delivered on this order is not greater in quantity than the minimum required commensurate with eco-
nomic delivery and permissible inventory, at the expected rate of use, taking into consideration supplies on hand and

on order.

Section 35 (A) of the United States Criminal Code ‘
18, U. S. C. A. 80, makes it a criminal offense to make a aS ee
false statement or representation to any department or (Signature of official)
agency of the United States as to any matter within the

jurisdiction of any department or agency in the United ae “pot ee ee ees ee
States. (Date) (Title)

 

U.S. GOVERNMENT PRINTING CFFICE 16—25554-1