SURVEY RECORD ON TANK INSPECTION No.

:
AND TANK CLEANLINESS Date:

Shipper : ………………………………………………………
Commodity : ………………………………………………………
Means of transportation : ………………………………………………………
Loading port : ………………………………………………………
Discharging port : ………………………………………………………

RESULTS OF INSPECTION

1. DATE AND TIME OF SURVEY:

Survey commenced On ………………….. @ ………………………….

Survey completed On ………………….. @ ………………………….

2. INSPECTION:

Interior of tanks No. ………………………… .. were

Tank No. visually inspected by us as far as possible at
accessible points and found to be visually dry,
clean and odourless.
Pipelines, strainers in pumproom were visually
Pump and pipelines inspected at the opening as far as possible and
found to be visually clean & empty.
Pumproom seavalve

REP. OF REP. OF SURVEYOR

MEANS OF TRANSPORTATION