Burke County Fuel Ticket
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Date: (mm/dd/yy)
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Division or Agency?
EMS
Fire Marshal
Emergency Management
Sheriffs Office
Public Works
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Type of Fuel?
Diesel
Gasoline
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Gallons?
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County Vehicle #:
319
320
321
322
323
324
325
326
327
328
329
330
331
332
335
334
335
336
337
338
339
Other:
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Mileage
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Location Fuel Pumped From?
EMS Station 1
EMS Station 2
EMS Station 3
Other
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Employee Pumping Fuel?
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Indicates Response Required