570 



' 10. Was (were) tank(s) emptied?: 



11. Opening of applicable cargo tank valves and applicable line 



cut-off valves on completion of loading : [^J 



12. Closing of applicable cargo tank valves and applicable line 



cut-off valves on completion of loading :[^] 

 The undersigned certifies that in addition to the above, all sea valves, 

 overboard discharge valves, cargo tank and pipeline connections and 

 interconnections, were secured on completion of unloading of oil cargo. 



Date of entry Officer in charge 



■ Master ___, 



(d) Ballasting of cargo tanks : 



13. Identity of tank (s) ballasted: 



14. Date and position of ship at start of ballasting : 



15. If valves connecting cargo lines and segregated ballast lines 



were used give time, date and position of ship when valves 



were (a) opened, and (b) closed: 

 The undersigned certifies that in addition to the above all sea valves, 

 overboard discharge valves, cargo tank and pipeline connections and 

 interconnections, were secured on completion of ballasting. 



Date of entry Officer in Charge 



Master 



(e) Cleaning of cargo tanks : 



16. Identify of tank (s) cleaned: 



17. Date and duration of cleaning : 



18. Methods of cleaning: [^] 



Date of entry Officer in charge 



Master '~ 



(f ) Discharge of dirty ballast : 



19. Identity of tank (s) : 



20. Date and position of ship at start of discharge to sea : 



• 21. Date and position of ship at finish of discharge to sea : 



22. Ship's speed (s) during discharge : 



23. Quantity discharged to sea : 



24. Quantity of polluted water transferred to slop tank(s) 

 ; (identify slop (tank (s)) : 



25. Date and port of discharge into shore reception facilities (if 



applicable) : 

 I 26. Was any part of the discharge conducted during darkness, if 



so, for how long : 

 27. Was a regular check kept on the effluent and the surface of the 



water in the locality of the discharge : 

 I 28. Was any oil observed on the surface of the water in the locality 



of the discharge : 

 Date of entry Officer in charge 



Master 



'Applicable valves and similar devices are those referred to in regulations 20(20) (a) 

 (111), 23 and 24 of Annex I of the Convention. 



^ Hand hosing, machine washing and/or chemical cleaning. Where chemically cleaned, 

 the chemical concerned and the amount used should be stated. 



