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pdfTANKER/BARGE MATERIAL INSPECTION
AND RECEIVING REPORT
Form Approved
OMB No. 0704-0248
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PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
1. TANKER/BARGE
2. INSPECTION OFFICE
LOADING REPORT
3. REPORT NUMBER
DISCHARGE REPORT
4. AGENCY PLACING ORDER ON SHIPPER, CITY, STATE AND/OR LOCAL ADDRESS (Loading)
5. DEPARTMENT
6. PRIME CONTRACT OR P.O. NUMBER
7. NAME OF PRIME CONTRACTOR, CITY, STATE AND/OR LOCAL ADDRESS (Loading)
8. STORAGE CONTRACT
9. TERMINAL OR REFINERY SHIPPED FROM, CITY, STATE AND/OR LOCAL ADDRESS (Loading)
10. ORDER NUMBER ON SUPPLIER
11. SHIPPED TO (Receiving Activity, City, State and/or Local Address)
12. B/L NUMBER
13. REQN. OR REQUEST NO. 14. CARGO NUMBER
15. VESSEL
16. DRAFT ARRIVAL
17. DRAFT SAILING
FORE
18. PREVIOUS TWO CARGOES
AFT
FORE
AFT
19. PRIOR INSPECTION
FIRST
LAST
21. APPROPRIATION (Loading)
20. CONDITION OF SHORE PIPELINE
23. PRODUCT
25.
22. CONTRACT ITEM NO.
24. SPECIFICATIONS
STATEMENT OF QUANTITY
LOADED
DISCHARGED
LOSS/GAIN
PER CENT
BARRELS (42 Gals) (Net)
GALLONS (Net)
TONS (Long)
26.
STATEMENT OF QUALITY
TESTS
27.
SPECIFICATION LIMITS
TIME STATEMENT
DATE
NOTICE OF READINESS TO LOAD DISCHARGE
TEST RESULTS
TIME
28. REMARKS (Note in detail cause of delays such as repairs, breakdown, slow
operation, stoppages, etc.)
VESSEL ARRIVED IN ROADS
MOORED ALONGSIDE
STARTED BALLAST DISCHARGE
FINISHED BALLAST DISCHARGE
INSPECTED AND READY TO LOAD DISCHARGE
CARGO HOSES CONNECTED
COMMENCED LOADING DISCHARGE
STOPPED LOADING DISCHARGING
RESUMED LOADING DISCHARGING
FINISHED LOADING DISCHARGING
CARGO HOSES REMOVED
VESSEL RELEASED BY INSPECTOR
29. COMPANY OR RECEIVING TERMINAL
COMMENCED BUNKERING
FINISHED BUNKERING
(Signature)
VESSEL LEFT BERTH (Actual/Estimated)
30. I CERTIFY THAT THE CARGO WAS INSPECTED, ACCEPTED AND
LOADED/DISCHARGED AS INDICATED HEREON.
(Date)
DD Form 250-1, NOV 92
31. I HEREBY CERTIFY THAT THIS TIME STATEMENT IS
CORRECT.
(Signature of Authorized Government Representative)
Previous edition may be used.
(Master or Agent)
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File Type | application/pdf |
File Title | DD Form 250-1, Tanker/Barge Material Inspection and Receiving Report, November 1992 |
Author | WHS/ESD/IMD |
File Modified | 2007-06-05 |
File Created | 2004-03-02 |