Attachment 8 DLA Form 1367 .pdf

SHIPMENT RECEIPT/DELIVERY PASS I lfflrnbedby. SOP416001-1» Spoll\OC Di<p0<1b00 s,n,,..

CUSTOMER ACCT: DATE

CUSTOMER NAME:

VEHICLE TYPE LICENSE PLA TE NO STATE

DIGITAL WEIGHT INDICATOR & PRINTER TICKET

Il.. • lbs.GROSS

Il.. .. lbs. TARE

Il.. ♦ lb�NET

WEIGHMASTERS INITIALS/DATE DRIVER ON OFF cJ

CUSTOMERIAGENT/DATE PASSENGER ON □ OFF :J

WEATHER: SNOW RAIN [j N/A

- LJ

REMARKS

1. TO: PURCHASER OR AGENT (Namo of Camo,, Il Appl1cab/o) 2. FROM: (Namo and !ocohon of Acriv,ty and lnstollat1on !rom wh1ch ptoperry ,s bomg removcd)

LOGEX System lnternational GmbH DLA Disposition Services

Processing Plant: xxxxxxxxxxxxxxx Kaiserslautern, Germany

3. TASK OROER NUMBER 20F2023

◄. CONTRACT NUMBER

SP4520-16-D-0003

S. CLIN 6. OESCRIPTION OF MATERIAL 7. UNIT 8. RElEASED

OUAtlHTY

2009KB Ferrous metals, light and heavy mixed: SCL=E1I; Heavy EA ferrous metals, road wheels and tank track and sprockets: SCL=E11, E1V; EWC = 170405. 191202, 200140

Container 1: 2360449 Weight Ticket #: 1929 KG 21,680

Container 2: 2360450 Weight Ticket #: 1929 KG

Container 1: Container 2: Total 21,680 Seal: 706737 Seal: 708861 Seal: 706776 Seal: 706759 Seal: Seal:

Seal: Seal:

Seal: Seal:

Seal: Seal:

•••••••··•·•···•••····•··••·•····· Nothing Follows··•···················•···•···•

SCTCode: E1VR2B

Manifest #

9. SHIPMENTNUMBER z 19A. ·x-TYPEOFSHIPMENT 10. TIME LOAOEO 11. VEHICLE LICENSE NO.

PARTIAL IZJ FINAL O 7:27 KL EN 909

1�. , , ___ , __ _. D, \,.

aturc 01 Autnonzeo H:ep1esen1a11vc1 13. TITLE OF AUTHORIZEO OISPOSAL

REPRESENTATIVE RELEASING PROPERTY

--/, � Mr. COR Contractina Officer Reoresentative

14. SIGNA TURE OF PURC°HASER OR AGENT 15. DATE PROPERTY lS RELEASEO

� ,4 printed name Mr. OST or Agent 19-Feb-2020

"//// TO BE COMPLETEO BY SECURITY PERSONNEL ONL Y

16. TIMe $fil�MENT LEAVES INSTALLATION 17. SENTRY'S INITIALS

OLA FORM 1367, AUG 2018 POF (DLAI

xxxyyyzzz

Attachment 8

SP4500-21-R-0003

Europe Scrap

D Kaiserslautern

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125301014355175138

25301007013976 24

2530 011393748 6

25301002935137 4

,2530,01102471311

2530 013102237 ,1

12530 015321569 1 j253oioo1013976i11

2530 1 015321569 1

2530 012014816 1

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02/19/2020

IF E ITRACK SHOE ASSEMBLY IMl10117A0

H E WHEEL,SOLID RUBBER M110118A0

H E WHEEL,SOLID RUBBER IM110119A0

IF ,E WHEEL,SOLID RUBBER IM110119A0

1H E WHEEL,SOLID RUBBER ÌM110119AO

H ,E WHEEL,SOLID RUBBER iM110119AO

ÌH ÌE iwHEEL,SOLID RUBBER IM110119AO

H E WHEEL,SOLID RUBBER IM110119A0

H E WHEEL,SOLID RUBBER ÌM110119AO

H IE IWHEEL,SOLID RUBBER jM110119A0

H !E 1 TRACK SHOE ASSEMBLY jM110124AO

F E 1 TRACK SHOE,VEHICULA i Ml101COMP20A22AO oorM0015oo9o/ 1 111111m11 111�nmm1111111111 1111 1111111111im1111111rn1m11111 2530 0158761411560 E1V 21,654 F iE TRACK SHOE,VEHICULA Mll01COMP34A38A0

Jntainers (kg) 21,680kg 21,680-26=21,654

:RTIFYTHAT THE ITEM(S) LISTED HEREON HAS/HAVE BEEN

VllLITARIZED IN ACCORDANCE WITH DoD MANUAL 4160.28, LUME 3, DEFENSE DEMILITARIZATION; PROCEDURAL GUIDANCE, rEGORY I-XXI, PARAGRAPH ALL.

. PROPERTY ON THIS LISTING HAS BEEN PROPERLY

v1ILITARIZED BYTHE USE OF THE CONTRACTOR'S

�CH CUTTING, SMELTING OR HAMMERMILL/SHREDDER.

Tota I · 21,680:

?r SIGNATURE (CERTIFIER):

DATE: 11 1,( t Vl.4 PRINTED:

TITLE: DEMIL CERTIFIER (LOGEX)

PHONE: xxxxxxxxxxx xxxxxxxxx

ADDRESS: xxxxxxxxxxxxxxxx wfì SIGNATURE (VERIFIER)�l(i

DATE: /0.fR�l�ò PRINTED: xxxxxxxxxxxxxxxxx

TITLE: Property Disposal Specialist GRADE: �xxxx-PHONE:

{COM) xxxxxxxxxxxxxxxxx

ADDRESS: CENTRALIZED DEMIL DIVISION KAISERSLAUTERN, DE

DemiL Certification Attachment 8

SP4500-21-R-0003

MUTILATION CERTIFICATION

"I certify mutilation was accomplished in accordancewith DRMS-I4160.14"

Ferrous metals, light and heavy mixed: SCL=E1I; Heavy

Description: ferrous metals, road wheels and tank track and sprockets: SCL=E11, E1V; EWC = 170405, 191202, 200140

CLIN: 2009KB Weight:2/ 6KO/(;, v l /1 +t lt 2J2tJ Signature Date xxxxx xxxxxx

Typed/Printed Name Certifier

;0Jeh2wo Date Signature vflilcl

OQ u i

Typed/Printed Nàme Verifier xxxxxx xxxxxxxxxxxxx

Attachment 8

SP4500-21-R-0003