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BUNKER!DELIVERY!NOTE!(BDN)!&!MARPOL!SAMPLE!RECORD!

Ships!Name!
!
e!
!
Ships!IMO!Number!
!
e!
!

!
!

Bunker!Barge/!
Supplier!Name!
!
e!
Barge!IMO!Number!

!
!

BDN!!
MARPOL! MARPOL!
NNC!Issued:!Y/N,!to!
Compliant! Sample!
Sample! 1.!Flag:!Y/N,!copies!to!
(Y/N)!
Seal!No.! Complaint! 2.!Port!BSRS:!Y/N!
(Y/N)!
3.!Supplier:!Y/N!
4.!Ships!files!Y/N!
5.!Others!(specify)!

Date!!F.O!
Fully!
Consumed!

Date!MARPOL!
Sample!
Destroyed/!
Released!
(>!12!months)!

Date!BDN!
Remark!and!
Destroyed
Signature!of!
/!Released!
Duty!Officer!
(>!36!
responsible!for!
months)! F!O!Changeover!

!
MASTERS!SIGNATURE!

Date!

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