ATT 3 DD250-1.pdf

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TSURUMI BARGE TRANSPORTATION SERVICES
Solicitation number
SPE602-21-R-0707
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DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

DD FORM 250-1, NOV 92

Page of

DRAFT

INSTRUCTIONS

NEEDS DD67

PREVIOUS EDITION IS OBSOLETE.

DD FORM XXXX, 20YYMMDD DRAFT

Page of

TANKER/BARGE MATERIAL INSPECTION AND RECEIVING REPORT

OMB No. 0704-0248 OMB approval expires: 20240131 The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0248). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

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

16. DRAFT ARRIVAL

17. DRAFT SAILING

18. PREVIOUS TWO CARGOES

25. STATEMENT OF QUANTITY

LOADED

DISCHARGED

LOSS/GAIN

PER CENT

BARRELS (42 Gals) (Net) GALLONS (Net) TONS (Long)

26.STATEMENT OF QUALITY
27.TIME STATEMENT

DATE (YYYYMMDD)

TIME

NOTICE OF READINESS TO LOAD DISCHARGE

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

COMMENCED BUNKERING

FINISHED BUNKERING

VESSEL LEFT BERTH (Actual/Estimated)

29. COMPANY OR RECEIVING TERMINAL

30. I CERTIFY THAT THE CARGO WAS INSPECTED, ACCEPTED AND LOADED/DISCHARGED AS INDICATED HEREON.

31. I HEREBY CERTIFY THAT THIS TIME STATEMENT IS CORRECT.

9.0.0.2.20120627.2.874785

WHS

DD250-1, "Tanker/Barge Material Inspection and Receiving Report"

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