EQUIPMENT INTERCHANGE RECEIPT AND INSPECTION REPORT WHETHER OR NOT A SEPERATE EQUIPMENT INTERCHANGE CONTRACT HAS BEEN EXECUTED BETWEEN THE OCEAN CARRIER AND THE MOTOR CARRIER THE LATTER EXPRESSLY AGREES TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN OCEAN CARRIERS STANDARD EQUIPMENT INTERCHANGE CONTRACT AND ACKNOWLEDGES THIS FACT BY SIGNING THIS INSPECTION FORM.

CONTAINER NUMBER

CHASSSIS NUMBER

FULL

EMPTY

IN

OUT

TYPE

SIZE

DATE/TIME

CARRIER INFORMATION
CARRIER SCAC	TRUCK COMPANY	DRIVER NAME	TELEPHONE	TRUCK LICENSE #/ STATE

CONTAINER INFORMATION
SHIPPING LINE	SEAL NUMBER	CONT TARE WEIGHT
CHASSIS INFORMATION
CHASSIS PROVIDER	LICENSE NUMBER/STATE	CHASSIS TARE WEIGHT
CARGO INFORMATION
VESSEL/VOYAGE	BOOKING NUMBER/BILL OF LADING	DISCHARGE PORT

COMMODITY

CARGO WEIGHT (LBS)

YARD LOCATION

HAZARD CLASS

PT #

CONSOL #

SHIPPER

REEFER INFORMATION
BOOKED TEMP	SET TEMP	READ TEMP	VENT POSITION	CLIP ON NUMBER		M.G. SET/GEN. NUMBER
REMARKS					FLIP REQUIRED

I HEREBY CERTIFY THAT ON THE DATE STATED FIRST ABOVE , I CAREFULLY INSPECTED THE EQUIPMENT DESCRIBED ABOVE, THAT THIS IS A TRUE AND CORRECT REPORT OF THE RESULT OF SUCH INSPECTION, AND THAT POSSESSION OF SUCH EQUIPMENT WAS TAKEN ON BEHALF OF THE CARRIER OR STATED STEAMSHIP CO. AT THE PLACE AND DATE INDICATED.
CLERK SIGNATURE	DRAYMAN'S SIGNATURE
THIS EQUIPMENT WAS RECEIVED/DELIVERED IN GOOD CONDITION EXCEPT AS NOTED ABOVE	THIS EQUIPMENT WAS RECEIVED/DELIVERED IN GOOD CONDITION EXCEPT AS NOTED ABOVE
PREPARED BY: