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PUBLIC WORKS TRAVEL FORM <br />TRAVEL EXPENS CLICK HERE FOR UST <br />PW DEPARTPA T c-ET5T-HERK FOR LIST <br />ONLY FILL IN BLUE SHADED AREAS <br />0G <br />Name: Tam, Do^ahue revs! 9 - & rcn 24,201T Personal ye'titae Mleage Information I O Read+n obi <br />TM-,6 to, <br />San Diego Home: C"manin Resod ebal <br />L!=,se Number <br />DO Reading <br />DDD Resting Tots D <br />Pu a <br />NPELRA nnuat nFsranee Add a s. 1 <br />DUD mg tart <br />0 0 Tool Tdp <br />Evert <br />Criy, Ste. Zhr <br />O RaaW End- <br />0 0 <br />Retmoursamen! <br />0 CO <br />DaFBS' V 94 V241=1 I have days 1 3Z1~11 3r 3r23/11 tndv[dua Totals <br />Tool <br />rave oenses: <br />Expense <br />CCC <br />Px <br />OPC <br />Pp <br />L'CC <br />PCC <br />Cr <br />PC <br />CCC <br />PCC <br />OPC <br />PD <br />L'..'C <br />PCC <br />OTC <br />PO <br />~ <br />Px <br />OPC <br />PC <br />CCC <br />Px <br />OPC <br />-0 <br />Braat!ast <br />1400 <br />7 00 <br />7 Go <br />7 co <br />7 GG <br />4200 <br />42.00 <br />4.nrJ+ <br />2260 <br />11 00 <br />".1 (RI <br />11 G6 <br />SS.GO <br />56.00 <br />Q, r.,,*, <br />46 CG <br />23 Op <br />23.00 <br />23M <br />11 5M <br />115A0 <br />haderarr8 <br />loco <br />am <br />Soo <br />5 co <br />5 00 <br />30.00 <br />30.60 <br />Hoe)' <br />21383 <br />21293 <br />21d 63 <br />21283 j <br />21233 <br />co !15 <br />1,0$3,16 <br />Reg stra4n <br />M 00 <br />59&= <br />595.00 <br />Tau <br />Pant <br />- <br />_ <br />Car rs~7 <br />I <br />AAam, <br />58500 <br />I <br />I <br />- J <br />59.3 GO <br />51=0 <br />S'cc <br />wrong <br />OA!LY <br />; <br />TOTAL <br />1,39283 <br />92Go <br />r. 2.83 <br />4800 <br />21253 <br />35 G0 <br />21483 <br />23-M <br />dt233 <br />4506 <br />724315 <br />WW <br />2,48515 <br />! <br />Total travel costs <br />3 248513 <br />Ttev rarnti m <br />$ <br />A--,* Codes: <br />$930-011 61711 <br />Amount <br />Title! Pva Diem <br />242 Co <br />Atoaur' es: <br />Amount <br />Acmurc Codes <br />Amo~rt <br />A=a tCo es <br />Arrount <br />Signature Date <br />Approval 4/2 . Date <br />Approval: , Date <br />OutofStateTravel Division Mgr Approval Date <br />Fill in BLUE areas only Do not enter any information in the YELLOW shaded areas <br />Recordmg mileage* Record your odometer before you begin your trip and when you reach your destination Additional spare Is !nciuded for multiple uses After your record your mileage, your <br />total reimbursement is automahcelly added in the'Rermbumement' box This will give you the <br />ioura you will receive DO NOT ENTER ANY INFORMATION IN THAT BOX <br />Please use per deem guidelines for meals $41 per day for meals and $5 for incidentals <br />If you are using a company credit card, please provide receipts If you need a cash rembursement, please provide receipts If you are uang per daim, no receipts are necessary If you are <br />tracking expenses, no receipts are necessary <br />