压载水报告表.doc

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1、BALLASTWATERREPORTINGFORM1.SHIPINFORMATION2.BALLASTWATERShip’sName:Type:IMONumber:SpecifyUnits:M3Owner:GrossTonnage:CallSign:TotalBallastWateronBoard:Flag:ArrivalDate:Agent:LastPortandCountry:ArrivalPort:TotalBallastWaterCapacity:NextPortandCountry:3.

2、BALLASTWATERTANKSBallastWaterManagementPlanonboard?YESNOManagementPlanImplemented?YESNOTotalnumberofballasttanksonboard:No.oftanksinballast:________________IFNONEINBALLASTGOTONo.5.No.oftanksexchanged:________________No.oftanksnotexchanged:____________

3、____4.BALLASTWATERHISTORY:RECORDALLTANKSTHATWILLBEDEBALLASTEDINPORTSTATEOFARRIVAL;IFNONEGOTONo.5.Tanks/HoldsBALLASTWATERSOURCEBALLASTWATEREXCHANGECircleone:Empty/RefillorFlowThroughBALLASTWATERDISCHARGE(Listmultiplesourcespertankseparately)DATEDDMMYYP

4、ortorLat/LongVolume(units)Temp(units)DATEDDMMYYEndpointLat/Long.Volume(units)%Exch.SeaHgt.(m)DATEDDMMYYPortorLat/LongVolume(units)Salinity(units)BallastWaterTankCodes:Forepeak=FP,Aftpeak=AP;DoubleBottom=DB;Wing=WT;Topside=TS;CargoHold=CH;Other=OIFEXCH

5、ANGESWERENOTCONDUCTED,STATEOTHERCONTROLACTION(S)TAKEN:________________________________________________IFNONESTATEREASONWHYNOT:___________________________________________________5:IMOBALLASTWATERGUIDELINESONBOARD(RES.A.868(20))?Y/.NC/O&CAPT.SIGNATUREDA

6、TERESPONSIBLEOFFICER’SNAMEANDTITLE(PRINTED)ANDSIGNATURE:___________________________DATE