IDENTIFICATION OF SHIP'S TANKS

Name of Ship___________________________________________________________

Official Number _________________________________________________________

Plan View of Cargo and Slop Tanks

(complete on board ship)

Identification Capacity
of Ship’s
Tanks

Depth of Slop Tank(s)

(Give Capacity of each tank and

the depth of each slop tank(s))
Name of Ship___________________________________________________________

15
Official Number _________________________________________________________

(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)

DATE CODE ITEM Record of operations/signature of officers in charge.

Master Signature: ___________________________________________________

Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 USC 1001).
Name of Ship___________________________________________________________

16
Official Number _________________________________________________________

(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)

DATE CODE ITEM Record of operations/signature of officers in charge.

Master Signature: ___________________________________________________

Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 USC 1001).
Name of Ship___________________________________________________________

Official Number _________________________________________________________

17