DD Form 250-1 Tanker/Barge Material Inspection and Receiving Report

TANKER/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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