Material Inspection And Receiving Report
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1Form Approved
MATERIAL INSPECTION AND RECEIVING REPORT
OMB No. 0704-0248
The public reporting burden for this collection of information is estimated to average 1.5 hours 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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0248), 1215 Jefferson Davis
Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subjected to any penalty for failing to comply with
collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONSCONTAINED IN THE DFARS, APPENDIX F-401.
1. PROCUREMENT INSTRUMENT
7.
6. INVOICE NO. / DATE
OF
8. ACCEPTANCE POINT
ORDER NO.
IDENTIFICATION (CONTRACT) NO.
PAGE
2. SHIPMENT NO.
3. DATE SHIPPED
4. B/L
5. DISCOUNT TERMS
CODE
CODE
9. PRIME CONTRACTOR
10. ADMINISTERED BY
CODE
CODE
11. SHIPPED FROM (If other than 9)
12. PAYMENT WILL BE MADE BY
CODE
CODE
13. SHIPPED TO
14. MARKED FOR
15.
16. STOCK/PART NO.
DESCRIPTION
17. QUANTITY
18.
19.
20.
ITEM NO.
(Indicate number of shipping containers - type of container - container number)
SHIP/REC'D*
UNIT
UNIT PRICE
AMOUNT
21. CONTRACT QUAALITY ASSURANCE
22. RECEIVER'S USE
Quantities shown in column 17 were received in
a. ORIGIN
B. DESTINATION
apparent good condition except as noted.
CQA
ACCEPTANCE
CQA
ACCEPTANCE
of listed items
of listed items
* If quantity received by the Government is the same as
quantity shipped, indicate by (X) mark; if different, enter
has been made by me or under my supervision and
has been made by me or under my supervision and
actual quantity received below quantity shipped and
they conform to contract, except as noted herein or
they conform to contract, except as noted herein or
encircle.
on supporting documents.
on supporting documents.
DATE
DATE
DATE
SIGNATURE OF AUTHORIZED
SIGNATURE OF AUTHORIZED
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
GOVERNMENT REPRESENTATIVE
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TYPED NAME:
TYPED NAME:
MAILING
MAILING
MAILING
ADDRESS:
ADDRESS:
ADDRESS:
COMMERCIAL TELEPHONE
COMMERCIAL TELEPHONE
COMMERCIAL TELEPHONE
NUMBER
NUMBER
NUMBER
CONTRACTOR USE ONLY
DD FORM 250 (AUG 2000)
PREVIOUS EDITIONS ARE OBSOLETE
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