MATERIEL INSPECTION AND RECEIVING REPORT

• Document Type: CREST
• Collection: NGA Records (Formerly NIMA)
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78B04747A001400030026-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 28, 2016
• Document Release Date: April 19, 2001
• Sequence Number: 26
• Publication Date: April 4, 1966
• Content Type: FORM

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8010?0?0
8 39 40 41 42 43 44 R5 46 47 48 49 50
6
AND
RECEIVING REPORT
2. FLOW CHART OR PROCEDURE NO. 3sHEET 4.N0. OF
78711-23 4 April 1966
NO. SHE TS
_
5. OFFICE ADMINISTERING CONTRACT 6. INSPECTION OFFICE
7. CREDIT VOUCHER OR FILE NO.
In ctior1 at Source
8. AGENCY PLACING ORDER ON SUPPLIER-CITY-STATE
9. PRIME CONTRACT OR P. 0. NO,
STATINTL
10. NAME OF PRIME CONTRACTOR-CITY-STATE
11. SUPPLEMENTS AND CHANGE ORDERS
1 RER OR WAREHOUSE SHIPPFF) - -
13. ORDER NO. ON SUPPLIER
14. SHIPPED TO-MARK FOR
15. PROC, DIR. OR REQUISITION NO.
STATINTL
16. SHIPMENT ORDER NO.
STATINTL
17. SHIPMENT NUMBER ON CONTRACT
A. PARTIAL B. FINAL
18. GROSS WEIGHT
19. NET WEIGHT
(Accountable Office when different)
20. DATE SHIPPED 21. SEAL NUMBERS 22. B/L OR REGISTRATION NO. 23. CAR N3.
24. ROUTING
Hand carr, - Contractor Per~.et
~ ITRACT STOCK ANDIOR PART NUMBER AND DESCRIPTION OF ARTICLES UN1T
rTEM
NUMBER (Indicate no. of shipping containers-Type of container-Container no
)
EA
QUANTITY QUANTITY UNIT
TOTAL COST
SHIPPED
.
M
S
25 26
27
RECEIVED COST
28 29 30 31
I U&t Table . I Asa7.
l
(*dvaanc.e Tilt-Top T ht Table)
STATINTL
Comwere Pack
Inspection at source by C
Acceptance at Destination
32. APPROPRIATION
C. ARTICLES SHOWN IN COLUMN 29 WERE RECEIVED IN APPARENT GOOD CONDITION,EXCEPT AS NOTED
DATE: INCHE.CKER:
33. INVOICE ROUTING
34. CLASS-CODE
36, ACCOUNT NO.-STORES ACCOUNT
36.DEBIT VOUCHER OR 1. R. NO.
A. I CERTIFY THAT THE ITEMS LISTED HEREIN HAVE BEEN INSPECTED BY ME OR UNDER
Y
B. I CERTIFY THAT I HAVE RECEIVED AND/OR ACCEPTED THE ARTICLES SHOWN HEREIN
M
SUPERVISION. THEY CONFORM TO CONTRACT. AND HAVE BEEN ACCEPTED, EXCEPT
(for use on Contract No. EXCEPT
Typed name of Inspector)
STATINTL
STATINTL
DI 62 53 54 55 56 57 5e 59 60 6
6
1 62 63
4 65 66 67 66 69 70 71 72 73 74 7:1 76 77 78 79 80 81 82 83 84 65 06 87 08 09 90 91 92 93 84 95 96 97 98 99 100
DD, OCT. 53 250
1J1ft`~'I t R~VfF_W BY NIMA / DoD
Approved For Release 2001/05/11 : CIA-RDP78BO4747AO01400030026-6
SHIPPIN' ' CON.
TAINr.,TALY 123 6
73