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Cargo Handling Temperature(!)ň/xS'/n Port of Loading/ DischargingYl Remarksk#nqelceňl{|12683530 &T'Yޏ/R\ ,gnm1-NX[ g NS}4l/al4l The ballast/bilge water remained in tanks on board: 1[S Tank No.4l(y{| kinds of waterpeϑ Quantitylf1[:NN(u/nmS}1bm'1 Indicating whether the tank is segrogted/ clean ballast tank or cargo tankY l Remarks,gnQY(W/nSۏL N\ON v^\ cĉ[SL3u This ship plans to carry out the following operation(s) in port and application will be submitted separately according to the relevant provisions: 1.nmm'1\ON4lm %/f / (&T 2.O(unmBR/mRBRm1 %/f / (&T tank washing (water wash) Yes No tank washing by detergent / additives Yes No 3.Slm1 %/f / (&T 4.ql\ON %/f / (&T crude oil washing Yes No gas freeing Yes No 5.T/nSc6eec>e+Tl/ g[ir(vm14l/mTir0 (TM3 dis$      6 8 B D Z \ ^ f j ɳխ՟ϟϳϟφϟ h'a CJo(h!ka>*CJo(h'r>*CJo( hU>*CJ hZCJo( hZCJ h};CJo( h'rCJ jRh'rCJ h};CJ hUCJ hUCJo( hUo(hUh"ACJOJPJaJo(hUCJOJPJaJo(1$D  d v   0 < \ $d$&`#$/Ifa$d8d$gd$da$ $NdVD^Na$$da$     $ < > B F J \ ^ b f l t    $ & F H V ^ b d t ¼͔~~~ hUCJ hUCJo(h'a >*CJo( h'a CJo(ht4>*CJo(h(u>*CJo(h!ka>*CJo( hZCJ h'rCJh'rCJOJQJo( h};CJo( hUCJ h};CJ hUCJo( hU>*CJh,->*CJo(h};>*CJo(1    $ . 0 : \ h j n 2 6 J N T V ^ ` h j r t x z ~ "6>^bv24@BȻȻȵȻȻ hUCJ hUCJo( hUCJo( hU>*CJ hf-CJo( h{>CJ hUCJ h/iCJo( hgCJo(h,-h,-CJaJo(h,-hUCJaJh,-hUCJaJo( hUCJ hUCJo(:\ 2 8 H J V ` j v x | ~ FfZ$$&`#$/Ifa$gd{>$$&`#$/Ifa$Ff.$d$&`#$/Ifa$$Gd$&`#$/IfUD"]Ga$ $6@^dv2DT $d$Ifa$d8 TVXZ\^`UOOOOO$IfkdX$$IfJr &U  044 laBVb  26>@B$FJRTVv~&&'('*','.''****hs0CJaJo(hwCJaJo(hUCJaJhUCJaJo(U hUCJH* hU>*CJ% jRhghgCJOJQJaJo(hUCJOJQJhUCJOJQJo( hUCJo( hUCJ hUCJ9`bDUPPPPPPPd8kd)$$IfMr &U  044 laposal of tank washing water/ water containing harmful substances/mixtures into port reception facilities, estimated quantity tons (M3) yQXf,gnň}'ir[hQN2algfNSefNPY 96g 0YN^nwQYň} N'irvňagNv^`Qck8^ 'irDePhQ 3ubQ[cknxe0 This is to declare that this ship s certificates concerning safe transportation and pollution Prevention are all valid and complete; the ship s construction, equipment and arrangements are in good condition and meet the requirements of fitness for carrying the above declared goods; the documentation of goods is complete and the declaration is ture and correct. DN NUS0De96VM|fN0*fN0lal_c[lN#NOifN0qlalg_c[lN#NOifN01US0YXbf The following document(s) and information are submitted in addition: 9/3ubNXT _ N 96/NtNvz Master/declarer: Ship / Agent (Seal) 9fNS/3ubNXTWYHhS####01 eg2015-04-15 Certiticate No: Date: ;N{:gsQ~{h Remarks by the Administration'}%`T|NY T05u݋0 Ow05uP[{ _ N Kb:g137######## Emergency Contact Person s Name, Tel, Fax and E-mail :dk3ubUSN_ NN vQ-N$NN3ubNYucTR/nS\ON NNYu;N{:gsQX[g0 This declaration should be made in tripartite, one is kept by the Administration for file, and two for the declarer and port operator respectively.        .''*+++f,,--*-f- $$Ifa$ *d$If *d8$If d8$IfBd8WD^`B ****++++++++++,(,*,>,f,r,t,,,,,,, ----(-h--- .l.//////پٵǭپپФٝ~p~hU5OJQJ\aJo(hUhUCJOJPJQJaJo( hUCJ hUCJ hUCJo(hhCJaJo(h.|ECJaJh~VCJaJo(hU>*CJaJh.|ECJaJo(hUCJaJo(hUCJaJhCCJaJo(hs0CJaJo(hs0hs0CJaJo(*f-h--. .'akd$$If4%%044 laf4$Ifqkd$$Ifl0%3 044 la .n./////////////////////////d41$0]0 dpWD`d8////////////////////////0hUhg:hujhuUmHnHuhxjhxU///////////////////////00000 0 0 0000000000 0"0$0&0(0*0,0.00020406080:0<0>0@0B0D0F0F0H0J0L0N0P0R0T0V0X0Z0\0^0`0b0d0f0h0j0l0n0p0r0t0v0x0z0|0~00000000000000000000000000000000000000000000000000000001:2P. 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