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(Date) <br />Name <br />Organization <br />Address <br />City, State, Zip <br />Description <br />Equipment <br />Category <br />Attachment F <br />King County FFY02 DOJ Equipment Grant <br />SAMPLE HAND RECEIPT <br />I hereby acknowledge receipt of the following equipment from the State Domestic <br />Preparedness Program. <br />Model Serial (if any) Quantity <br />Item I Unit Cost Qty Size Total Cost Discipline <br />Personal MSA, APR Advantage 1000, Face $127.62 18 1GG $2,297.16 (18) LEA <br />Protective piece law enforcement. Item <br />available in small, medium, and <br />large; please specify quantity of <br />each .size. <br />MSA, Advantage CBA -RCA $23 63 36 N/A $850.68 (36) LEA <br />canister, used for chem /bio and <br />riot control. <br />Detection Siemens EPD Mk2 Dosimeter $450.00 4 N/A $1800 00 (4)HAZMAT <br />IrDA Dosimeter Reader 1 $120.00 1 1 N/A f $120.00 1(1) HAZMAT <br />Page 1 of 1 <br />Total Jurisdictional Request: <br />Sales Tax: <br />Grand Total: <br />$5,067.84 <br />$445.96 <br />5,513.80 <br />