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MARPOL Advance Notification Form For Waste Delivery 17 May.2017
MARPOL Advance Notification Form For Waste Delivery 17 May.2017
1.1 Name of ship: CFS PALAMEDES 1.5 Owner or operator: CFS Agent: PEREZ Y CIA
1.2 IMO number: 9322841 1.6 Distinctive number or letters: 6YRJ2
1.3 Gross tonnage: 7578 1.7 Flag State: MONTEGO BAY / JAMAICA
1.4 Type of ship: Oil tanker Chemical tanker Bulk carrier Container
Other cargo ship Passenger ship Ro-ro Other (specify)
2.2 Arrival Date and Time: 17.05.2017 / 1200 2.7 Date of Last Delivery: 02.05.2017
2.3 Departure Date and Time: 17.05.2017/ 2300 2.8 Next Port of delivery (if known):
2.4 Last Port and Country: Guanta / Venezuela 2.9 Person submitting this form is (if other than the master):
C. Officer Ernesto Florez
2.5 Next Port and Country (if known): Manzanillo /Panama
MARPOL Annex I – Oil Quantity (m3) MARPOL Annex V – Garbage Quantity (m3)
1
I confirm that I am delivering all the waste held on board this vessel (as shown on page 1) at this port □
Port at which Estimate amount of
Maximum dedicated Amount of waste remaining waste will waste to be generated
Type
storage capacity m3 retained on board m3 be delivered (if between notification and
known) next port of call m3
MARPOL Annex I – Oil
Oily bilge water N/A N/A N/A N/A
2
APPENDIX 2
The designated representative of the reception facility provider should provide the following form to the master of a ship that has just
delivered waste.
This form should be retained on board the vessel along with the appropriate Oil RB, or Garbage RB
__________________________________________________________________________________________
2. SHIP PARTICULARS
2.1 Name of ship: CFS PALAMEDES 2.5 Owner or operator: CFS Agent PEREZ Y CIA
2.2 IMO number: 9322841 2.6 Distinctive number or letters: 6YRJ2
2.3 Gross tonnage:7578 2.7 Flag State: MONTEGO BAY/JAMAICA
2.4 Type of ship: Oil tanker Chemical tanker Bulk carrier Container
Other cargo ship Passenger ship Ro-ro Other (specify)
Signature : ……………………………………….