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Nationality: Berthing Port of Departure: Time of Arrival: @b g?N? *? !k? ?% ?Q/n \ON?lMO: ¨¾'??e??? Owner: Voyage No. Departure Berth: 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 ,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???? 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