Form Approved

MATERIAL INSPECTION AND RECEIVING REPORT OMB No. 0704-0248

Public reporting burden for this collection of information is estimated to average 30 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 forreducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for
Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction
Project(0704-0248), Washington, DC 20503. Resondents 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 EITHER OF THESE ADDRESSES.
SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.

1. PROCUREMENT INSTRUMENT ID (CONTRACT) NO. ORDER NO. 6. INVOICE NO./DATE 7. PAGE OF 8. ACCEPTANCE POINT
SPRDL1-15-C-9001
1 3 Source
2. SHIPMENT NO. 3. DATE SHIPPED 4. B/L 5. DISCOUNT
TERMS
MPT0001 2020JUL18 TCN X1HLD90200A001XXX B
9. PRIME CONTRACTOR CODE 1HLD9 10. ADMINISTERED BY CODE S1002A
Mil-Pac Technology DCMA ORLANDO
1672 Main Street 3555 MAGUIRE BLVD
Ramona, CA 92065 ORLANDO, FL 32803-3726

11. SHIPPED FROM (if other than 9) CODE 1HLD9 FOB: D 12. PAYMENT WILL BE MADE BY CODE HQ0338
Mil-Pac Technology DFAS-COLUMBUS CENTER
1672 Main Street SOUTH ENTITLEMENT OPERATIONS
Ramona, CA 92065 P.O BOX 182264
COLUMBUS, OH 43218-2264

13. SHIPPED TO CODE W90454 14. MARKED FOR CODE

SU W4GG HQ US ARMY TACOM RECEIVING OFFICER
TEAM ARMOR PARTNERSHIP FACILITY NON-MILSTRIP
WHSE BLDG 88037 LOGISTICS LANE
FORT HOOD, TX 76544-5060

15. ITEM NO. 16. STOCK/PART NO. DESCRIPTION 17. QUANTITY 18. 19. UNIT PRICE 20. AMOUNT
(Indicate number of shipping containers - type - container number.) SHIP/REC'D * UNIT

0001AA 5998-01-562-6596 6 EA 12,765.00 $76,590.00

MICROWAVE RECEIVER ASSM
P/N: 12472808-2
UID: D2429012472808-2000004
D2429012472808-2000005
D2429012472808-2000006
D2429012472808-2000001
D2429012472808-2000002
D2429012472808-2000003

0002AA 5998-01-562-0877 2 EA 17,450.00 $34,900.00

CALIBRATION SYSTEM

Sub-Total: $111,490.00
Freight Charge: $0.00
SHIPPING WT: 22 CUBE: CNTRS: Total Amount: $111,490.00
21. CONTRACT QUALITY ASSURANCE 22. RECEIVER'S USE
A. ORIGIN B. DESTINATION Quantities shown in column 17 were received in
X X apparent good condition except as noted.
CQA ACCEPTANCE of listed items has been CQA ACCEPTANCE of listed items has
made by me or under my supervision and they conform been made by me or under my supervision and
to contract, except as noted herein or on supporting they conform to contract, except as noted
documents. herein or on supporting documents.
DATE RECEIVED SIGNATURE OF AUTHORIZED GOVT REP
TYPED NAME:
TITLE:
DATE SIGNATURE OF AUTHORIZED GOVT REP DATE SIGNATURE OF AUTH GOVT REP ADDRESS:
TYPED NAME: SW3218 TYPED NAME:
TITLE: MPC DLA DISTRIBUTION SAN DIEGO RECVTITLE: COMMERCIAL
ADDRESS: 3581 CUMMINGS ROAD BLDG 3581 ADDRESS: PHONE NO:

SAN DIEGO, CA 92136-3581 (US) *If quantity received by the Government is the
same as quantity shipped, indicate by a check-
COMMERCIAL COMMERCIAL mark; if different, enter actual quantity
PHONE NO: PHONE NO: received below quantity shipped and encircle.

23. CONTRACTOR USE ONLY

PREVIOUS EDITION IS OBSOLETE. Mil-Pac Form: MPLF0001.017-001012

DD Form 250, AUG 2000 http://milpac.com (858)495-1400
 Form Complies PAGE OF
WAWF Receiving Report / Invoice (continuation) With FAR 53.105 2 3

PIIN: SPIIN: SHIPMENT:

SHIPMENT NO. DATE SHIPPED PROC. INSTRUMENT IDEN. (CONTRACT) (ORDER) NO. INVOICE NO.
MPT0001 2020JUL18 SPRDL1-15-C-9001
ITEM STOCK/PART NO. DESCRIPTION QUANTITY
NO. (Indicate number of shipping containers - type of container - container number.) SHIP/RECD UNIT UNIT PRICE AMOUNT

0002AA ---- (continued) ----

P/N: 12472812-A
UID: D1HLD912472812-A00031
D1HLD912472812-A00032

------- RFID Container Data -------------

Pallet 2F02031323334350000000F4
Case 2F12031323334350000000F5
0001AA UID: D2429012472808-2000001
0001AA UID: D2429012472808-2000002
0001AA UID: D2429012472808-2000003

Pallet 2F02031323334350000000F6
0001AA 2F12031323334350000000F7 D2429012472808-2000001
0001AA 2F12031323334350000000F8 D2429012472808-2000002

Pallet 2F02031323334350000000F9
0001AA 2F12031323334350000000FA D2429012472808-2000003

Pallet 2F02031323334350000000FB
0001AA 2F12031323334350000000FC D2429012472808-2000004
0001AA 2F12031323334350000000FD D2429012472808-2000005

Pallet 2F02031323334350000000FE
0001AA 2F12031323334350000000FF D2429012472808-2000006
0001AA 2F1203132333435000000100 D2429012472808-2000001

Pallet 2F0203132333435000000101
0001AA 2F1203132333435000000102 D2429012472808-2000002
0001AA 2F1203132333435000000103 D2429012472808-2000003

Pallet 2F0203132333435000000104
Case 2F1203132333435000000105
0001AA UID: D2429012472808-2000004
0001AA UID: D2429012472808-2000005
0001AA UID: D2429012472808-2000006
0001AA UID: D2429012472808-2000001
0001AA UID: D2429012472808-2000002
0001AA UID: D2429012472808-2000003

Pallet 2F0203132333435000000106
Case 2F1203132333435000000107
0001AA UID: D2429012472808-2000004
0001AA UID: D2429012472808-2000005
0001AA UID: D2429012472808-2000006
0001AA UID: D2429012472808-2000001
0001AA UID: D2429012472808-2000002
0001AA UID: D2429012472808-2000003

WA250C, Aug 05 Previous edition may be used. Mil-Pac Form: MPLF0075.018-061003

http://milpac.com (760)788-3030
 Form Complies PAGE OF
WAWF Receiving Report / Invoice (continuation) With FAR 53.105 3 3

PIIN: SPIIN: SHIPMENT:

SHIPMENT NO. DATE SHIPPED PROC. INSTRUMENT IDEN. (CONTRACT) (ORDER) NO. INVOICE NO.
MPT0001 2020JUL18 SPRDL1-15-C-9001
ITEM STOCK/PART NO. DESCRIPTION QUANTITY
NO. (Indicate number of shipping containers - type of container - container number.) SHIP/RECD UNIT UNIT PRICE AMOUNT

-------- (RFID Data continued) --------

Pallet 2F0203132333435000000109
0002AA 2F120313233343500000010A D1HLD912472812-A00031
0002AA 2F120313233343500000010B D1HLD912472812-A00032

RFID Tags CLIN Qty

----------------- --------------------
Pallets: 9 0001AA 24 EA
Cases: 14 0002AA 2 EA
UIDs: 0

UID Items: 26

WA250C, Aug 05 Previous edition may be used. Mil-Pac Form: MPLF0075.018-061003

http://milpac.com (760)788-3030