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: