'€CAMERON

FREE ISSUE GOODS I MATERIALS RECEIPT FORM

We ¥9.~.Y.Y.~.'.9.~(~
..~gg hereby confirm that the Goods / Materials as detailed on the attached
delivery note, supplied as free issue to us have been received, checked us and are undamaged.
We undertake to adequately and securely store these Goods / Materials and accept that we will be responsible for the
cost of any subsequent damage to or loss of these Goods I Materials.

Project Name: Project Number:

PEMEX AKAL-J Produced Water R-AH0018

Cameron PO Number: Vendor Name:

Pending I Cameron
I
Description I Quantity Of Free Issue Goods I Materials:

70 Spray nozzle veejet 1/2" npt

I
.
Date Goods Received:
7-26-13
Certification received with Goods I Materials Yes/~
(delete as appropriate)

I Name Billy Durocher

I Date 7-26-13
Please complete and return this form by scanning then email together with a copy of the delivery documentation
(including packing list) and any certification received direct to the buyer.
 Packing List
ftCAMERON
Delivery No : 85197717
Creation Dt : 07-24-2013
Delivery Dt : 07-16-2013
Page : 1 of 1
BOL No
A133
New Iberia Mfg - Curtis Lane Terms
5315,5413,5416, and 5419 Curti Sales Order :4510166873
NEW IBERIA LA 70560 Sales Contact
USA

Sold To: Ship To: 903214

MAX WELDERS, LLC

188 Blackwater Ct
GIBSON LA 70356-3735
USA
Cust. Order No :

Ship From New Iberia Mfg - Curtis Lane NEW IBERIA Carrier:

Material Order Shipped Country of Due UOM

Item
Description Qty Qty Origin Qty

10 3P-150000 10 o 70 o EA
SPRAY NOZZLE VEEJET 1/2" NPT H-1/2"NPT-

Packaging Details: Total Number of Packages: 1

Description Net Weight Total Weight Dimensions

BOX 20 LB 20 LB 10 X 10 X 7
Total Weight 20.000 LB

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