Anexo 3.

DECLARACION JURADA DE RECEPCION Y PROCESAMIENTO DE RESIDUOS O DESCARTE Y MATERIA PRIMA POR SELECCIÓN POR TALLA, PESO O CALIDAD DE RECURSOS HIDROBIOLOGICOS, STOCK Y MOVIMIENTOS DE HARINA Y ACEITE RESIDUAL

Yo,………………………………………………………………………………………………….........................................................................................................................................Identificado con DNI/CE N°………………………......……………………………………………………...… Representante legal de la empresa .............................................................………………………………………………………………………………………………………….,Titular de la licencia de

operacion otorgada mediante Resolución N°..................................................................................................................... ..............................................................................................dedicada a la activ idad de .................................................................................................ubicada en....Pasaje virgen guadalupe s/n san bartolo S anta...............................................................................................
distrito...CHIM BOTE................................................provincia................SA NTA..................................................departamento..........................ANCA SH.................................., DECLARO BAJO JURA MENTO Y EN ESTRICTO HONOR A LA VERDAD, que los datos que a continuacion se detallan refleja con exactitud las cantidades recepcionadas y procesadas de recursos hidrobiologicos y las cantidades de producto
terminado

S AL DO EN TOT AL DE T OTAL DE PESO DE HARINA

FECHA DE PROCEDENCIA (PLANTA CHD) PLACA DE TRANSPORTE GUIA DE RE MISI ON ESPECIE RESIDUOS (T) REP. PESAJE RESIDUO DE SCARTE REPORTE PESAJE DESCARTE S ALDO MAT. PRIMA TO TAL DE MAT . MAT . PRI MA POZA HARINA N° SACOS % DE RENDIMIENTO FACT OR DE ACEIT E % DE RENDIMIENTO F ACTO R DE NU MERO DE CERTI FICADO Y/O ACEIT E STOCK HARINA STOCK DE ACEITE
RECEPCIO N REM ITE NTE (ANCHOVET A) (DIA ANTE RI OR) PRI MA (t) PROCE SADA (t) PRODUCIDA (t) CONVE RS ION PRODUCIDO CONVERSIO N DE PROCEDENCIA TRANSPORTADA
(t)

2-Apr-18 B Y S SAC WE-2261 0002-00002980 CABALLA 7.130

0.000 23.570 23.570 0.000 3.800 76 16.12% 6.203 0.350 1.485% 67.3 73.360 2.500
2-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002571 CABALLA 6.230 4465
2-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002572 CABALLA 10.210 4466

3-Apr-18 PESQ. NAFTES W5T-739 006-000112 CABALLA 9.330 1. CP-0218-658-

0.000 28.700 28.700 0.000 4.800 96 16.72% 5.979 0.350 1.220% 82.0 19.220 58.940 2.850
3-Apr-18 CORP. DE ALI. MAR. T2U-914 0001-000043 CABALLA 10.160 000046-2018
3-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002573 CABALLA 9.210 4481

4-Apr-18 B Y S SAC WE-2261 0002-00002983 CABALLA 8.220

4-Apr-18 CORP. DE ALI. MAR. T4V-900 0001-000044 CABALLA 7.430
4-Apr-18 PESQ. NAFTES W5T-739 006-000114 CABALLA 9.630 0.000 45.970 35.620 10.350 6.250 125 17.546% 5.699 0.370 1.039% 96.3 65.190 3.220

4-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002575 CABALLA 10.340 4498
4-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002574 CABALLA 10.350 4496

5-Apr-18 PESQ. B Y S WE-2261 0002-00002985 CABALLA 9.650 10.350 28.750 0.000 28.750 0.000 0 0.00% 0.000 0.000 0.00% 0.0 1. CP-0218-658- 3.220 65.190 0.000
000047-2018
5-Apr-18 PESQ. NAFTES M3U-741 006-000115 CABALLA 8.750

6-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002576 CABALLA 7.940 4525 1. CP-0218-658-
28.750 48.000 43.510 4.490 7.900 158 18.16% 5.508 1.000 2.298% 43.5 30.000 43.090 1.000
6-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002577 CABALLA 6.820 4526 000048-2018

6-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002578 CABALLA 4.490 4527

7-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002579 ANCHOVETA 4.950 4539 1. CP-0218-658-
4.490 28.870 28.870 0.00 3.750 75.00 12.99% 7.70 0.800 2.771% 36.09 1.800 46.840 0.000
7-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002580 CABALLA 11.160 4540 000049-2018

7-Apr-18 PESQ. NAFTES W5T-739 006-000119 CABALLA 8.270

9-Apr-18 CORP. DE ALIMENTO MARI. T2U-914 0001-000047 MACHETE 7.620

9-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002581 CABALLA 9.420 4555 1. CP- 0218-658-
0.00 42.070 32.660 9.410 5.150 103 15.77% 6.34 2.000 6.124% 16.33 000050-2018 2.000 51.990 0.000
9-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002582 CABALLA 4.160 4557
9-Apr-18 B Y S SAC WE-2261 0002-00002992 CABALLA 11.460

9-Apr-18 CORP. DE ALIMENTO MARI. T4V-900 0001-000049 MACHETE Y 9.410

CAB ALLA

10-Apr-18 PESQ. NAFTES WI-2931 006-000120 CABALLA 5.950

10-Apr-18 Pacific Natural Foods S.A.C. T2U-914 004-0002583 CABALLA 8.100 4571 9.410 34.630 23.460 11.170 6.850 92 29.20% 3.42 1.475 6.287% 15.9 58.840 1.475
10-Apr-18 CORP. DE ALIMENTO MARI. P1G-877 0001-000050 MACHETE 3.520
10-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-0002584 CABALLA 7.650 4573
- - - - -
11.170 14.410 0.000 14.410 0.000 0.000 0.00% 0.000 0.000 0.00% 0.000 58.840 1.475
11-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-0002585 CABALLA 3.240

1. CP-0218-658-
23.320 42.670 2.950
12-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002586 CABALLA 10.250 000051-2018

14.410 36.970 36.970 0.000 7.150 143 19.34% 5.17 1.475 3.990% 25.1 1. CP-0218-658-
12-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002587 CABALLA 4.320 000052-2018 8.490 34.180 2.950

12-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002588 ANCHOVETA 7.990 1. CP-0218-658- 2.950 34.180 0.000
000053-2018

0.000 5.280 0.000 5.280 0.000 0 0.00% 0.000 0.000 0.00% 0.000 34.180 0.000
13-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-0002590 CABALLA 5.280

14-Apr-18 Pacific Natural Foods S.A.C. F4J-720 004-00002591 ANCHOVETA 2.0585

14-Apr-18 Pacific Natural Foods S.A.C. D3F-858 004-00002592 ANCHOVETA 2.5800

14-Apr-18 Pacific Natural Foods S.A.C. D4A-789 004-00002593 ANCHOVETA 3.5495

14-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002594 CABALLA 8.000 5.280 38.185 38.185 0.000 8.600 152 22.52% 4.44 1.500 3.928% 25.46 42.780 1.500
14-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002589 ANCHOVETA 8.200

14-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-0002595 CABALLA 3.870

14-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-0002596 CABALLA 1.210

14-Apr-18 Pacific Natural Foods S.A.C. D4J-942 004-00002597 ANCHOVETA 3.4370

16-Apr-18 CORP. ALI. MARITIMOS T2U-914 0001-000053 CABALLA 4.200

16-Apr-18 Pacific Natural Foods S.A.C. T2U-914 004-00002600 ANCHOVETA 3.520
1. CP-0218-658-
0.000 21.887 21.887 0.000 4.850 77 22% 4.513 0.400 1.828% 54.7 1.900 47.630 0.000
16-Apr-18 Pacific Natural Foods S.A.C. A OG-903/A5A-992 004-00002598 ANCHOVETA 3.177 000054-2018

16-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002599 CABALLA 7.190

16-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002601 CABALLA 3.800

17-Apr-18 B Y S SAC WD-1175 0002-00003003 CABALLA 11.170

17-Apr-18 CORP. ALI. MARITIMOS T2U-914 0001-000055 CABALLA 11.380 1. CP-0218-658-
0.000 40.900 34.400 6.500 5.850 101 17.01% 5.880 1.410 4.099% 24.4 1.410 53.480 0.000
17-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002603 CABALLA 7.250 000055-2019
17-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002602 CABALLA 6.500
17-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002604 ANCHOVETA 4.600

6.500 9.570 0.000 9.570 0.000 0 0.00% 0.000 0.000 0.00% 0.0 53.480 0.000
18-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002606 CABALLA 3.070

19-Apr-18 B Y S SAC WD-1175 0002-00003008 CABALLA 5.610

9.570 31.330 31.330 0.000 5.800 116 18.51% 5.40 0.100 0.319% 313.3 1. CP-0218-658- 21.960 37.320 0.100
19-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002608 CABALLA 2.970 000056-2019
19-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002607 CABALLA 13.180

20-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002609 CABALLA 10.670

20-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002611 CABALLA 4.750 0.000 32.950 0.000 32.950 0.000 0 0.00% 0.000 0.000 0.00% 0.0 37.320 0.100
B Y S SAC CABALLA
20-Apr-18 WE-2261 0002-00003009 11.030
Pacific Natural Foods S.A.C. ANCHOVETA
20-Apr-18 WG-2931 004-00002610 6.500

21-Apr-18 PESQ. NAFTES WE-2308 006-000136 CABALLA 7.580

21-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002612 CABALLA 9.140

32.950 66.380 66.380 0.000 10.050 201 15.14% 6.60 0.500 0.753% 132.76 47.370 0.600
21-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002613 CABALLA 8.900
21-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002614 CABALLA 4.980

21-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002615 CABALLA 2.830

24-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002616 CABALLA 12.710 0.000 23.060 0.000 23.060 0.000 0 0.00% 0.000 0.000 0.00% 0.0 47.370 0.600
24-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002618 CABALLA 10.350

25-Apr-18 B Y S SAC WD-1175 0002-00003017 CABALLA 8.100

25-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002619 CABALLA 9.130
23.060 55.900 50.870 5.030 8.250 165 16.22% 6.17 0.300 0.590% 169.6 55.620 0.900
25-Apr-18 PESQ. NAFTES T1E-707 006-000140 CABALLA 6.500
25-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002621 CABALLA 4.080
25-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002622 CABALLA 5.030

26-Apr-18 PESQ. NAFTES WE-2308 006-000141 CABALLA 10.750

5.030 35.030 0.000 35.030 0.000 0 0.00% 0.000 0.000 0.00% 0.0 55.620 0.900
26-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002620 CABALLA 9.570
26-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002623 CABALLA 9.680

27-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002624 CABALLA 8.010

35.030 56.550 48.470 8.080 8.100 162 16.71% 5.98 0.200 0.41% 242.35 1. CP-0218-658- 10.160 53.560 1.100
27-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002625 CABALLA 5.430 000057-2019
27-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002627 CABALLA 8.080

28-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002628 CABALLA 2.750

8.080 23.190 23.190 0.000 3.800 76 16.39% 6.10 0.050 0.216% 463.8 57.360 1.150
28-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002626 CABALLA 7.380
28-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002629 ANCHOVETA 4.980

30-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002631 ANCHOVETA 7.130

30-Apr-18 Pacific Natural Foods S.A.C. B6F-781 004-00002630 ANCHOVETA 2.160 0.000 17.120 17.120 0.000 3.550 71 20.74% 4.82 0.050 2.921% 342.4 60.910 1.200
30-Apr-18 Pacific Natural Foods S.A.C. P1G-877 004-00002632 JUREL 5.970
30-Apr-18 Pacific Natural Foods S.A.C. WG-2931 004-00002633 JUREL 1.860