Form S 045 Rev 1.

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MATERIAL RECEIVING
INSPECTION REPORT
CONTRACTOR: PACKAGE NAME/NO:
P.O. No.: SYSTEM DECRIPTION:
SUPPLIER: SYSTEM NO: ID -
SHIPPED BY: PROJECT NO:
MRIR No.: MRIR DATE: DATE RECEIVED:
DELIVERY CARRIER: PKG SLIP NO.:
YES NO N/A
FREIGHT BILL NO.: CAR NO.:
O,S & D REPORT ISSUED & ATTACHED
NCR’(s) ISSUED & CLOSED
SPECIAL HANDLING & STORAGE PROCEDURE REQUIRED & IMPLEMENTED
VENDOR INSPECTION RELEASE CERTIFICATE ISSUED
ITEM NO.: TAG NUMBER QTY DESCRIPTION REMARKS

PREPARED BY CONTRACTOR APPROVED BY BLLP APP.D BY CLIENT (if applicable)

NAME NAME NAME
SIGNATURE SIGNATURE SIGNATURE
DATE DATE DATE