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)

- - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0

0.000 10.050 0.000 8.370 1.590
4-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002410 ANCHOVETA 10.050 000 3602 10.050 0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0!

- - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0

1. CP-0218-658-
10.050 11.870 11.870 000001-2018 3.160 6.810 1.640
5-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002411 ANCHOVETA 1.820 000 3615 0.000 1.600 32 13.48% 7.420 0.050 0.42% 237.4

- - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0

0.000 10.120 0.000 6.810 1.640
11-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002412 ANCHOVETA 10.120 000 3627 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0!

- - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0

12-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002413 CABALLA 2.370 000 3640
12-Jan-18 Grupo Empresarial Ortiz S.A.C. T4V-900 0002-0001411 ANCHOVETA 5.960 000 3639 10.120 28.790 0.000 6.810 1.640
28.790 0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0!
12-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002414 ANCHOVETA 10.340 000 3641

- - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0

0.000
0.000
28.790 35.470 35.470 0.000 11.210 1.840
4.400 88 12.40% 8.060 0.200 0.56% 177.4
0.000
13-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002415 ANCHOVETA 2.470 000 3653 0.000
13-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002416 CABALLA 4.210 000 3654 0.000

15-Jan-18 - - - - - - - - - - - 0 0 0 0 0 0 0 0 1. CP-0218-658- 1.380 11.210 0.460

000002-2018

- - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0

0.000 10.880 0.000 11.210 0.460
16-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002417 ANCHOVETA 10.880 000 3667 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0!
- - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0
0.000
10.880 34.420 23.000 13.760 0.660
17-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002420 ANCHOVETA 11.420 000 3682 0.000 2.550 51 11.09% 9.020 0.200 0.87% 115.0
17-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002419 ANCHOVETA 12.120 000 3680 0.000
- - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0
11.420 23.290 0.000 0.000 13.760 0.660
0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0!
18-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002421 ANCHOVETA 11.870 000 3695 0.000
- - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0
0.000
0.000
23.290 46.439 46.439 19.410 2.260
19-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002422 ANCHOVETA 11.730 000 3707 0.000 5.650 113 12.17% 8.210 1.600 3.23% 29.0
19-Jan-18 Grupo Empresarial Ortiz S.A.C. T2U-914 0002-0001418 ANCHOVETA 8.630 000 3708 0.000
19-Jan-18 Pacific Natural Foods S.A.C. M5N-847 004-00002424 ANCHOVETA 2.789 000 6358 0.000
20-Jan-18 - - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0
20-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002425 ANCHOVETA 7.080 000 3722 0.000 17.860 17.860 0.000 1. CP-0218-658- 5.400 16.210 2.660
2.200 44 12.32% 8.110 0.400 2.29% 44.7 000003-2018
20-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002426 ANCHOVETA 10.780 000 3724 0.000

20-Jan-18 - - - - - - - - - - - 0 0 0 0 0 0 0 0 1. CP-0218-658- 2.580 16.210 0.080

000004-2018

1. CP-0218-658-
20-Jan-18 - - - - - - - - - - - 0 0 0 0 0 0 0 0 000005-2018 9.460 6.750 0.080

23-Jan-18 - - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0

23-Jan-18 Pacific Natural Foods S.A.C. A7B-808 004-00002429 ANCHOVETA 5.714 000 6376 0.000
23-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002428 ANCHOVETA 10.420 000 3737 0.000
0.000 40.734 40.734 12.300 1.480
23-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002427 ANCHOVETA 8.230 000 3738 0.000 5.550 111 13.62% 7.340 1.400 2.46% 29.1
23-Jan-18 Grupo Empresarial Ortiz S.A.C. T2U-914 0002-0001421 ANCHOVETA 5.190 000 3739 0.000
23-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002430 ANCHOVETA 11.180 000 3740 0.000
- - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0
24-Jan-18 Pacific Natural Foods S.A.C. C7N-821 004-00002432 ANCHOVETA 4.238 000 6383 0.000 17.498 0.000 0.000 1. CP-0218-658- 1.390 12.300 0.090
0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0! 000006-2018
24-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002431 ANCHOVETA 13.260 000 3752 0.000
25-Jan-18 - - - - - 0.000 0.000 0 0.00% 0.000 0.000 0.00% 0.0
0.000
0.000
1. CP-0218-658-
17.498 48.488 48.488 2.990 16.160 1.990
25-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002433 ANCHOVETA 11.400 000 3766 0.000 6.850 137 14.13% 7.080 1.900 2.06% 25.5 000007-2018
25-Jan-18 Grupo Empresarial Ortiz S.A.C. T4V-900 0002-0001424 ANCHOVETA 7.160 000 3768 0.000
25-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002434 ANCHOVETA 12.430 000 3763 0.000
26-Jan-18 - - - - - 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% 0.0
1. CP-0218-658-
0.000 12.360 0.000 000008-2018 1.990 16.160 0.000
26-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002435 ANCHOVETA 12.360 000 3781 0.000 0.000 0 #DIV/0! 0.000 0.000 0.00% #DIV/0!

27-Jan-18 Pacific Natural Foods S.A.C. H1M-863 / M1Q- 004-00002437 ANCHOVETA 7.049 6398 0.000
989
4.050 81 8.69% 3.275 0.000 0.00% 0.0
27-Jan-18 Pacific Natural Foods S.A.C. A7G-902 004-00002439 ANCHOVETA 2.699 6400 0.000
27-Jan-18 Pacific Natural Foods S.A.C. D4A-789 004-00002440 ANCHOVETA 3.519 6402 12.360 46.617 46.617 0.000 23.310 1.910
27-Jan-18 0.000
27-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002436 ANCHOVETA 9.520 000 3793 0.000 3.100 62 6.65% 3.244 1.910 4.10% 24.4
27-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002438 ANCHOVETA 11.470 000 3794 0.000

29-Jan-18 - - - - - - - - - - - 0 0 0 0 0 0 0 0 1. CP-0218-658- 1.910 23.310 0.000

000009-2018

1. CP-0218-658-
29-Jan-18 - - - - - - - - - - - 0 0 0 0 0 0 0 0 5.620 17.690 0.000
000010-2018

30-Jan-18 Pacific Natural Foods S.A.C. A7N-871 004-00002443 ANCHOVETA 5.070 6411 0.000
30-Jan-18 Pacific Natural Foods S.A.C. D4A-789 004-00002444 ANCHOVETA 3.073 6409 0.000
3.000 60 8.91% 4.660 0.000 0.00% 0.0
30-Jan-18 Pacific Natural Foods S.A.C. T1R-926 004-00002447 ANCHOVETA 2.718 6417 0.000
0.000 33.654 33.654 23.440 0.200
30-Jan-18 Pacific Natural Foods S.A.C. A4O-963 004-00002445 ANCHOVETA 3.124 6414 0.000
30-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002441 ANCHOVETA 9.100 3822 0.000
2.750 55 8.17% 1.188 0.200 0.59% 168.3
30-Jan-18 Pacific Natural Foods S.A.C. WG-2931 004-00002446 ANCHOVETA 10.570 3823 0.000
H1M-863 / M1Q-
31-Jan-18 Pacific Natural Foods S.A.C. 004-00002450 ANCHOVETA 6.743 6423 - 6420 0.000
989 2.350 47 7.55% 5.411 0.000 0.00% 0.0
31-Jan-18 Pacific Natural Foods S.A.C. A7N-871 004-00002451 ANCHOVETA 5.974 6428 0.000 31.137 31.137 0.000 28.390 2.220
31-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002448 ANCHOVETA 13.780 3835 0.000
2.600 52 8.35% 0.878 2.020 5.78% 15.4
0.000
31-Jan-18 Pacific Natural Foods S.A.C. P1G-877 004-00002449 ANCHOVETA 4.640 3836