Attachment_07_DLA_Form_1367.docx

Clear )Attachment 7 SP4500-19-R-0016 Japan Scrap

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SHIPMENT RECEIPT/DELIVERY PASS

1. TO: PURCHASER OR AGENT

(Name of Carrier, If Applicable)

2. FROM:

(Name and Location of Activity and Installation From Which Property is being Removed)

3. INVITATION NUMBER

4. CONTRACT NUMBER

5.

ITEM

6.

DESCRIPTION OF MATERIAL

7.

UNIT

8.

QUANTITY

RELEASED

9. SHIPMENT NUMBER

9A. "X" TYPE OF SHIPMENT

PARTIAL

FINAL

10. TIME LOADED

11. VEHICLE LICENSE NO.

12. RELEASED BY

(Signature of PDO or Authorized Representative)

13. TITLE OF AUTHORIZED DISPOSAL REPRESENTATIVE RELEASING PROPERTY

14. SIGNATURE OF PURCHASER OR AGENT

15. DATE PROPERTY IS RELEASED

TO BE COMPLETED BY SECURITY PERSONNEL ONLY

16. TIME SHIPMENT LEAVES INSTALLATION

17. SENTRY'S INITIALS

DLA FORM 1367, MAY 74 (EG) REPLACES DD FORM 1460 WHICH MAY BE

USED UNTIL EXHAUSTED

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