FM-SOM-A-16-01-R00
PARTI
For all garbage other than cargo residues as defined In regulation 1.2 (Definitions)
‘Ship’s name Distinctive number or letters IMO number
‘TB.WIRA PRATAMA YOC 6082 9945710
Garbage categories:
‘A Plastics; B-Food waste; C-Domestic wastes (paper products, rags, glass, metal, bottles, crockery,
etc.); D-Cooking oil; E-Incinerator ashes; F-Operational wastes; G-Animal carcasses; H-Fishing gear;
Electronic waste
Operational discharges under MARPOL Annex V reg. 4 (Discharge of garbage outside special areas),
reg. 5 (Special requirements for discharge of garbage from fixed or floating platforms) or reg. 6
(Discharge of garbage within special areas) or chapter 5 of part I-A of the Polar Code.
Date | Ship position Categ | Estimated Estimated | Remarks: Sign
I (lat. / long.) ory amount amount (eg.
Time | or port if disposed of discharged incinerated | start/stop
ashore or name of Into | To (m3) time and
ship if discharged to sea_| reception position of
another ship (m3) | facilities incineration
orto 3
another general
ship (m3) remarks)
n7 93) Peoe Compre Beary = = 25:00
loqjujaa|Peor Caaiplax Sloas [= = 5-00
(oi/ujaz | Reve Caaplare 5 er 7 = 23.30
[Wafer] Beve Comptoir 8 [ee = - ‘B00
puf2z | Reve Camps A__ lees > 5 22.50
lina (22| Reve Campton 6 [oes = = 2200
ge /22] Reve Uamipta 6 ta = = ZE-00
i /n/o2| on pA Boas = . FT
pbhupoe ioe Cériplow a |005 = = 27-30
Exceptional discharge or loss of garbage under regulation 7 (Exceptions)
Date/ | Portorship | Category | Estimated amount | Remarks on the reason for | Sign
Time | position lost or discharged | the discharge or loss and
(lat. / long. (m3) general remarks (e.
and water reasonable precautions
depth if taken to prevent or
known) ‘minimize such discharge or
accidental loss and general
remarks)
IY Musrrse 2029.
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