NAME OF VESSEL:      …………………              Call sign.…………..

 

PORT OF REGISTRY AND DATE  :                     ……………………………………………

 

LAST PORT OF DELIVERY OF THE WASTE:………………………………..  DATE:………………….

ARE YOU DELIVERING   ALL                   SOME                            NONE                OF THE WASTE?

TYPE AND AMOUNT OF WASTE:

MARPOL CAT		TYPE	Specification	To be delivered (m3)	Maximum dedicated storage capacity (m3)	Amount of waste retained on board (m3)	Port at which remaining waste will be delivered	Estimated amount of waste to be generated between notification and next port of call (m3)
I	Oil	cargo residues
		bilges
		sludge
		ballastwaters
		Other (to be specified)
II	Chemicals	cargo – residues (to be specified)
		washing waters
		Other (to be specified
IV	Sewage	black water
		grey water
V	Garbage	cargo associated waste
		food waste
		plastic
		dry cargo residues (to be specified
		small dangerous waste