پنج شنبه ۲ شهریور ۱۳۹۶

BALLAST WATER REPORTING FORM

[To be completed for all vessels arriving in B.I.K Sea Area Port]

اداره کل بنادر و دریانوردی استان خوزستان

بندر امام خمینی(ره)

 

شماره:  PS-07-F12-00

1. VESSEL INFORMATION                                                    2. BALLAST WATER

Specify Units :M3,MT,LT,ST

IMO Number :

Type:

Vessel Name :

Total Ballast Water on Board :

Call Sign :

GT:

Owner:

Agent :

Arrival Date :

Flag

Total Ballast Water Capacity:

Arrival port :

Last port and country

 

 

 Next port and country

 

3. BALLAST WATER TANKS Is THERE A BALLAST WATER MANAGEMENT PLAN ON BOARD? YES …………. NO …….. HAS THIS BEEN IMPLEMENTED? YES ……… No …….. TOTAL NO.OF TANKS ON BOARD ………. NO. OF TANKS IN BALLAST ……… IF NONE IN BALLAST GO TO NO 5 YES…….. NO……….

NO. OF TANKS EXCHANGED………. NO. OF TANKS NOT EXCHANGED …………

4. BALLAST WATER HISTORY: RECORD ALL TANKS THAT WILL BE DEBALLASTED IN PORT STATE OF ARRIVAL, IF NONE GO TO NO. 5

BW DISCHARGE

BW EXCHANGE: circle one: Empty/Refill or Flow Through

BW SOURCE

Tanks/holds [list multiple sources/tanks separately]

SALINITY

[units

Volume [units]

PORT or LAT. LONG

Date ddmmyy

SEA Hgt.{m}

Exch %

Volume [units]

ENDPOINT

LAT.LONG

Date ddmmyy

TEMP

[units]

Volume [units]

PORT or LAT. LONG

Date ddmmyy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ballast Water Tank Codes : Forepeak=FP, Aftpeak=AP ,Double Bottom=DB, Wing=WT, Topside= Ts, Cargo Hold=CH,O= Other

 

 

 

 

 

 

 

 

 

 

 

IF EXCHANGES WERE NOT CONDUCTED, STATE OTHER CONTROL ACTION(S) TAKEN:

IF NONE, STATE REASON WHY NOT:

5. IS THERE A BALLAST WATER MANAGEMENT PLAN? YES……… NO…………

RESPONSIBLE OFFICERS NAME AND TITLE {PRINTED}AND SIGNATURE: ……………………………………………

 

MASTER

  به روز رسانی :  1395/10/10    یوسف مرادپور