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Get VA 3075 1991-2024

Pe) OFFICIAL PURPOSE (See note on reverse side of form) PLANNED ITINERARY FROM 1 1 TO EST. DURATION OF STOP First entry must be the place vehicle is to report. REQUESTED FOR (Date and time) RETURN PICK-UP (Date and time) REQUESTING OFFICIAL (Signature) APPROVED BY (Signature) PART II - DISPATCHER, DRIVER, AND USER TRIP OR LOAD RECORD PASS. OR WT. SPEEDOMETER READING FROM TO TO TO TO TO TO TO TO TIME DATE IN IN OUT OUT OUT TOTAL TIME OF TRIP HOURS SPEEDOMETER READ.

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