??>?? ik????h??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????[? ?R??0bjbj????2F??? ????????KK+/+/+/?????/?/?/8w/4?/l?/?P600000?4"?4 ?4?O?O?O?O?O?O?O$?S?dVZ?O]+/?4[4_4^?4?4?OKK00DFP?:?:?:?4?K? 0+/0?O?:?4?O?:?:??K??)@?N0????@L??z??/?8?[NF?O\P0?P?NF?V?9??V??N?V+/?N??4?4?:?4?4?4?4?4?O?O?:?4?4?4?P?4?4?4?4?????????????????????????????????????????????????????????????????????V?4?4?4?4?4?4?4?4?4 : 9?6?}??qSi?/al?gqS?['`'?ir3u?bUS Declaration Form For Hazardous Goods Carried By Ships ?ce¨¾?mSOir(? ? ?Bulk Liquids ? 9? T? ?V M|? ( ?/n ?Y?S/n: ?b/n?e??? Ship s name? ###n? Nationality: -N?V Berthing Port of Departure: 'Y? Time of Arrival: 2015-04-17 09:00 @b g?N? *? !k? ?% ?Q/n \ON?lMO: ¨¾'??e??? Owner: ####lQ?S Voyage No. ### Departure Berth: ??\##?lMO Time of Loading: '?ircknx??? T?y Proper Shipping Name of The Goods?y{|/'`(? Category/ propertyqS??S UN No.pe ??(T ? Quantity(Ton)?m'?1??S Number of tanks?m1??`S?/f/&T ?Tank inerting (yes/no)¨¾xS'?ir)n?^?! ? Cargo Handling Temperature(!)¨¾/xS'?/n Port of Loading/ DischargingY?l Remarks?k#n?q?e?lce¨¾?l{|12683530 &T'Y?/R??\ ,gn??m1?-NX[ g N???S}?4l/al4l? The ballast/bilge water remained in tanks on board: 1??[?S Tank No.4l(??y{| kinds of waterpe? Quantity?lf?1??[:NN(u/nm?S}?1?b?m'?1? Indicating whether the tank is segrogted/ clean ballast tank or cargo tankY ?l Remarks,gn??QY(W/n?S?L? N??\ON ?v^\ c??[?SL?3u??? This ship plans to carry out the following operation(s) in port and application will be submitted separately according to the relevant provisions: 1.nm?m'?1?\ON?4lm ? ?%/f / (&T 2.O(unmBR/?m?RBRm1? ?%/f / (&T tank washing (water wash) Yes No tank washing by detergent / additives Yes No 3.?S?lm1? ?%/f / (&T 4.q?l\ON ?%/f / (&T crude oil washing Yes No gas freeing Yes No 5.T/n?S?c6e???e?c>e+T?l/ g?[ir(??vm1?4l/?mTir0???? (T?M3 ? dis$??????????????      6 8 B D Z \ ^ f j ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ???????????????????????????????????????¦Õ? h'a CJo(h!ka>*CJo(h?'r>*CJo( h?U?>*CJ h?Z?CJo( h?Z?CJ h};?CJo( h?'rCJ jR?h?'rCJ h};?CJ h?U?CJ h?U?CJo( h?U?o(h?U?h?"ACJOJPJaJo(h?U?CJOJPJaJo(1$???D  ? d v ? ? ? ? ?   0 < \ ???????????????????$d?$?????&`#$/??Ifa$d8?d$?gd??$d??a$ $?N?d??VD??^?N?a$$d??a$?     $ < > B F J \ ^ b f l t ? ? ? ? ? ? ? ? ? ? ? ? ?    $ & F H V ^ b d t ? ? ? ? ? ?????????????????????????????????????~?~?~ h?U?CJ h?U?CJo(h'a >*CJo( h'a CJo(h?t4>*CJo(h?(u>*CJo(h!ka>*CJo( h?Z?CJ h?'rCJh?'rCJOJQJo( h};?CJo( h?U?CJ h};?CJ h?U?CJo( h?U?>*CJh,-?>*CJo(h};?>*CJo(1? ?    $ . 0 : \ h j n ? ? ? ? ? ? ? ? 2 6 J N T V ^ ` h j r t x z ~ ? ? ? ? ? ? ? "6>^bv???24@B????????????????????????????????????????????????????? h?U?CJ h?U?CJo( h?U?CJo( h?U?>*CJ hf-?CJo( h{>CJ h?U?CJ h/i?CJo( h?gCJo(h,-?h,-?CJaJo(h,-?h?U?CJaJh,-?h?U?CJaJo( h?U?CJ h?U?CJo(:\ ? ? ? ? 2 8 H J V ` j v x | ~ ? ? ? ??????????????????FfZ$$?????&`#$/??Ifa$gd{>$$?????&`#$/??Ifa$Ff.$d?$?????&`#$/??Ifa$$?Gd?$?????&`#$/??IfUD"]?Ga$? ? ? $6@^dv?2DT????????????? $d?$Ifa$d8? TVXZ\^`UOOOOO$If?kdX$$If??J?r????? ??&??U???? ?? ?0???????????????????????????????4?4? la?BVb????????  26>@B$FJRTVv~????????????????&?&'('*','.'?'?*?*?*?*?????????????????????????????????????????????????????????hs0?CJaJo(hw?CJaJo(h?U?CJaJh?U?CJaJo(U h?U?CJH* h?U?>*CJ% jR?h?gh?gCJOJQJaJo(h?U?CJOJQJh?U?CJOJQJo( h?U?CJo( h?U?CJ h?U?CJ9`b??D???UPPPPPPPd8??kd)$$If??M?r????? ??&U?? ? ?0???????????????????????????????4?4? la?posal of tank washing water/ water containing harmful substances/mixtures into port reception facilities, estimated quantity tons (M3) yQ?Xf,gn?¨¾}?'?ir?[hQN2?al?g??fN?S?efNP?Y ?9?6??g ?0??YN^nwQY¨¾}? N??'?ir?v?¨¾ag?Nv^?`?Qck8^ ?'?irD??eP?hQ ?3u?b?Q?[cknx?e?0 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. D???N NUS??0D??e?9?6??VM|??fN0?*???fN0?lal_c?[l?N#??N?Oi???fN0?q?lal?g_c?[l?N#??N?Oi???fN01?US0?YXb??f The following document(s) and information are submitted in addition: 9??/3u?b?NXT? _ N 9?6?/?Nt?N??v?z ? 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