594 



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



11. If not, quantity remaining in tank(s) : 



12. Is (are) tank(s) to be cleaned ? 



13. Amount transferred to slop tank : 



14. Identity of slop tank : 

 Sionature of Master 



(d) Ballasting of cargo tanks : 



15. Identity of tank (s) ballasted: 



16. Date and position of ship at start of ballastmg : 



(e) Cleaning of cargo tanks: 



Category A substances : 



17. Identity of tank(s) cleaned : 



18. Date and location of cleaning : 



19. Method (s) of cleaning : 



20. Location of reception facility used : 



21. Concentration of etHuent when discharge to reception facility 



stopped : 



22. Quantity remaining in tank : _ 



23. Procedure and amount of water introduced into tank in final 



cleaning : 



24. Location, date of discharge into sea : 



' 25. Procedure and equipment used in discharge into the sea : 

 Category B^ C and D substances : 



26. Washing procedure used : 



27. Quantity of water used : 



28. Date, location of discharge into sea : 



29. Procedure and equipment used in discharge into the sea:- 



(f ) Transfer of dirty ballast ivater : 



30. Identity of tank (s) : 



31. Date and position of ship at start of discharge into sea : 



32. Date and position of ship at finish of discharge into sea : 

 Signature of Master 



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



34. Quantity discharged into sea : 



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



(identify slop tank (s) ) : 



36. Date and port of discharge to shore reception facilities (if 



applicable) : 



(g) Transfer from slop tank /disposal of residue: 



37. Identity of slop tank (s) : 



38. Quantity disposed from each tank : 



39. Method of disposal of residue : 



( a ) Reception facilities : 



(b) Mixed with cargo : 



(c) Transferred to another (other) tank(s) (identify 



tank(s)): 



(d) Other method: 



40. Date and port of disposal of residue : 



