B3 WASTE DECLARATION

This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
10 IBC TANKS ( B104D ) PLASTIC PACKAGING vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 2,083 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
1 IBC TANK ( B104-D ) METAL PACKAGING vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 202 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
2 IBC TANKS ( B331-1 ) POT CRUCIBLE vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 1,313 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
1 IBC TANK ( B331-1 ) SLAG vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 814 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
1 IBC TANK ( A108D ) HOSE vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 384 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
1 IBC TANK ( A338-2 ) PER. LAB & GLASSWARE vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 198 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
1 IBC TANK ( A338-1 ) EXPIRED LIQUID CHEMICAL vehicle etc)
UN 1992 LIQUID, TOXIC N.O.S 340 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
1 IBC TANK ( A108D ) SOIL vehicle etc)
1 DRUM UN 3288 TOXIC SOLID INORGANIC N.O.S 733 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
2 DRUMS ( A331-2 ) SLUDGE OIL vehicle etc)
UN 1992 LIQUID, TOXIC N.O.S 400 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
2 DRUMS ( B107D ) AEROSOL vehicle etc)
UN 3288 TOXIC SOLID INORGANIC N.O.S 100 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management
 B3 WASTE DECLARATION
This form meets the requirement of SOLAS 74 chapter VII regulation 5 MARPOL 73/78 annex III regulation 4
Shipper ( Pengirim ) Reference Number ( Nomor referensi )
PT AGINCOURT RESOURCES
Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
Tapanuli Selatan, Sumatera Utara 22738, Indonesia
Emergency Call : +61 3 9663 2130 / +62 634 370 330

Consignee ( Penerima barang ) Carrier ( Pengangkut )

PT. PRASADHA PAMUNAH LIMBAH INDUSTRI ( PPLI )
Jl. Raya Narogong - Desa Nambo - Cileungsi PT. TANTO INTIM LINE
Bogor 16820 - Indonesia
+62 21 8674042 ( Hunting ) - +62 21 8673333 ( CS )
+62 21 8674043 ( FAX )
Container packing certificate / vehicle declaration Name , company / organization of signatory
( Sertifikat packing ) PT AGINCOURT RESOURCES
Declaration ( Pernyataan ) : Jl. Merdeka Barat Km 2,5, Desa Aek Pining, Batangtoru
It is declared that the packing of the container / vehicle Tapanuli Selatan, Sumatera Utara 22738, Indonesia
has been out in accordance with the general introduction
IMDG Code Place and date : Batang Toru, Tapsel -
( telah dinyatakan bahwa kemasan muatan didalam container
sudah sesuai dengan ketentuan umum IMDG Code ) Signature on behalf of packer ( tanda tangan dari yang
To be completed for shipments in containers or vehicles melakukan packing )
( muatan dalam container harus melampirkan sertifikat )

Ship's name and Voyage No. ( nama kapal dan voyage ) Port of loading ( pelabuhan muat )
KM TANTO ALAM V. 294 / 2124S SIBOLGA

Port of discharge ( pelabuhan bongkar ) ( Reserved for text, instruction or other matter )
JAKARTA

Marks & Nos. Number and kind of 'packages , proper shipping name, IMDG Gross Goods delivered as
(if applicable) class/division, UN number, packaging group (where assinged)**, mass
idetification flashpoint (in 0 C)**, control and emergency temperatures**, (berat) - ( ) Break bulk cargo
or registration identification of the goods as marine pollutant**, EmS No** and Kg ( X ) Unitized cargo
number(s) of MFAG table No** ( jumlah & jenis packing, nama barang, klas, ( ) Bulk packages
the unit nomor UN, group packing, titik nyala, temperature darurat,
identifikasi pencemaran laut, nomor EMS, nomor Tabel MFAG ) Type of unit
(container, trailer, tank,
2 JERRY CANS ( A106-D ) DIBK ( DIISO BUTYL KETONE ) vehicle etc)
UN 1992 FLAMMABLE LIQUID, TOXIC N.O.S 60 ( ) open
CLASS 6.1, PG I, F-A, S-A
CONT: DRYU 2322170 ( X ) close
SEAL : PTAR 0011560
**if required
Additional Information ( informasi tambahan )

Declaration ( Pernyataan ) Name , company / organization of signatory ( nama

I hereby declare that the contents of this consingment are fully perusahaan / organisasi ) :
and accurately described above by the proper shipping name(s) PT AGINCOURT RESOURCES
and are classified, packaged, marked and labeled/placarded
and are all respects in proper condition for transport according Date & place ( tanggal & tempat ) :
to the applicable International and National governmental Batang Toru, Tapsel - 25-Oct-2021
regulation ( dengan ini saya menyatakan bahwa isi dari
container yang sebenarnya, diklasifikasikan, dikemas Sign ( tanda tangan )
regulation ( dengan ini saya menyatakan bahwa isi dari
sesuai dengan peraturan International dan National yang
berlaku )
Arjuna Ginting / Superintendent Material Management
 nex III regulation 4

n of signatory

Aek Pining, Batangtoru

ara 22738, Indonesia

25-Oct-2021

( tanda tangan dari yang

r other matter )

Goods delivered as

( ) Break bulk cargo

( X ) Unitized cargo
( ) Bulk packages

Type of unit
(container, trailer, tank,
vehicle etc)
of signatory ( nama

Material Management