PT PERTAMINA PATRA NIAGA INTEGRATED TERMINAL BALIKPAPAN ‘STS BALIKPAPAN a (47 PERTAMINA PATRA NIAGA, ENDORSEMENT EX. DISCH : DATE : (MT. MEDELIN EXPO 04 Agustus 2023, [_3. [spurt carco qwew Bi) | 4. [ACTUAL RECEIPT SHORE TANK SUPPLY LOSSIGAIN SUPPLY LOSS IN % vs B/L |SHIP FIGURES AFTER LOADED [SHIP FIGURES BEFORE DISCH. ISHIP FIGURE AFTER DISCH. DISCHARGE LOSS/GAIN DISCHARGE LOSS IN % vs BIL ACTUAL RECEIPT IN LITER OBSERVED EX. B/L NUMBER : 8938723206 LONG TON 2,949,146 IFOIMFO-180 3.184.140 3.149.114 2,996,479 34 JULI 2023 BALIKPAPAN, 04 Agustus 2023, PT PERTAMINA PATRA NIAGA REPRESENTATIVECERTIFICATE OF QUANTITY DISCHARGE = PT PERTAMINA PATRA NIAGA M7™ PERTAMINA INTEGRATED TERMINAL BALIKPAPAN ( STS BALIKPAPAN ) Pret ironiro-te0 €£a0_ No 20/PNbe4te00/sTSFO 2028 RameotVessel | MP MEDELI EXPO Dare” Stage 2008 Bt Sescrasz03 teased at ITTERNMUAL MAKASSAR fe STSBALINPAPAN (MT CENDRAWASI/ 005) Nate —|_Volane] tires oer Tong Tans saris aah emp Tank ox Comp. Tank! ex.) crproduct |correction| at per | Motricton | per | Long Tons | 60°F Per | Barrels 60°F | Report (obed) | “rector | ast _ [tt on 008 ies 00 vies te. [et Quarry et 14920600 esre502 024988 ‘3002986 1.2080 bat quantity os722208 asv8so1 aeare 3028.99 2000.0 0.914025 SFAL 2.88661 eset sote.26 2eceate torrasti7 {a2 64,708 srB0 105385 aieess 30%s.80 zece.ase te77603 New BA Ship's Fou . . - 4 4 SFAD Ships Fue . . . 4 3 OB eter Sin scar 8 2osores 206.730 1.98700 90620 ‘2010.87 OB haber Ship Aer mnt sae saiseu 3, 005675 saszeaes Quant REceNED ws aase40 aausate 2essare odes eaten EW BIC HOTHER SAP STS7BILNoOSR . 7 7 5 rer. cece Toees EST a arse aaa] co) a8 hmnitisiabenimeell (%) 0,04%| 0.21% -0,64%| -0,64%| 0.21% -neManis? ar Ea aay TET ay TORT a =n] | ae ae ua ore a ea 23] a) a cas 1s Gaal orn] Sor Sea oon 7 ‘haa asee Tis] Testa ae om Sos oats ‘nem ‘nee cam aw wets eaeal 9] aasa wea om P2ou ‘sie sa an ae PT PERTAMINA PATRA NIAGA SURVEYOR, REPRESENTARVE, Name ord Sigrature Name ond Signature= 4&7 PERTAMINA . PT PERTAMINA PATRA NIAGA, PATRA NIAGA DISCHARGE AGREEMENT & [None ofSips NT NEDELNEXPO {oatng Por (mane. rah 07 /OW/ Vil /2023 Date & Time Arial : [Date 03 Agustus 2023 Date & Time Alongside Bertisety en OT CRmReR! Port ‘STS BALIKPAPAN [Start Date hes: Finish Date : es, RECEIVING AVAILABIUTY AND CAPACITY TT Quantity Disch Aw w; | teono-160 | +/-3000 1 Te F Komunikas pet Jam artara Nother Ship dengan Shute Sip erat formes Tota Volum yang tah Gong Komuniksi Radio VHF Chanel 0910, ase yang digunakanukuran 8 Inch Setting Tene: 2jam ——h ene Toad isch Master Remar: nthe event the cscharging ratelpressure at manifold ofthe vesslis below the agreement mention above then the vessel wl fasturcceigssrentoverceanes vessel fu. “The Ship must decare its Charter party’ discharging ra [enact hie line Pa (ratbonghax) VoyNo. No. Peayran a Leaieg zm (pea must) COP: Cargo Oi Purp (ampa ana) AL Obs Kilo Liter Observasi (Pengamatan) ‘Shore Darat (pihak penerima) tie ameter ipa dalam nhs Hs jam [sate Jens ustan F Fervard (Depan oer sey Namalepat sands (emnagaSEM) 4 Mid Tengat sro Ship's Faure Beare Discharge A =A (eltang) Keglatan bongkar harus drecord dalam pumping log dan ditandatangani pihak kapal dan pihak darat [__Penurunan tkanan rate ataspermintan dara! Kapal harus dibuatsecara tertulis dan dtandstanganipihak kapal & darat= A PERTAMINA Vent ane MY, Cenos/P.3005- Peto: STS Happen Loa Ship Pee Indeosia Dac Aug 42003 Maser Salina Wyo: y= 2023 cnr sss Dwr s6s0T BLN, DATE ‘STATEMENT OF ACTIVITY a scp [om i RET itm rr Ps Ara) read Bes a oon Fis om Gir Ps Piston Base Px Ar ston saan itn ssc ie - my a La Dax AM PERTAMINA cd PT. PERTAMINA INTERNATIONAL SHIPPING ‘SUB - HOLDING SHIPPING OPERATION DIRECTORATE. MT. CENDRAWASIH / P.3005 NOTICE OF READINESS VOYAGE 18 / L-2023 PORT 1 BALIKPAPAN DATE + August 3, 2023 TIME TENDERED = 13:30 To: PERTAMINA PATRANIAGA Dear sir, hereby tender you the MT. CENDRAWASIH/P. 3005 at the datetime shown above as being ready In all respect to commence the Loading into her compartments, Cargo to discharge of = Description of cargo Approximate amount / Bll of discharging quantity HSFO 180 : 3,000 co Laytime will commence as specified in the charter party covering this voyage. ‘TIME ACCEPTED 4948 Hour Augu Loading Masteroe int 228 eH 2, o Sar 2 s|sle| gel i {Tete anya pons pen ay 2 Biptens compte ergin pen een 4 Utyutonprtn ty ced esha eee COMPARTMENT LOG SHEET ‘BEFORE LOADING. = WP PERTAMINA. ConParruent LossHeeT Prams, cenaee ‘aise ees ml oa ae Zant Mama so pare, “August 4, 2023 > = ea ‘Asnowiasge Measurement 1h stove etapa Dich Pat aati onan 2 Sho wa croatian gh vere oon 2. Uterus wh il peter : 1500 aton Sigh ona (AV® PERTAMINA PT. PERTAMINA (PERSERO ) INTERNATIONAL SHIPPING ‘SUB - HOLDING SHIPPING OPERATION DIRECTORATE MT. CENDRAWASIH / P.3005 $$ EE Cm AAS P3005 ‘TO WHOM IT MAY CONCERN: ‘SLOP TANK'S CONTENTS Ship's Name MT. CENDRAWASIH Date + August 3, 2023 Voyage Number 18/1.-2023 DRAEL_: ee APs 4S M MD: 573 M TRIM AD 70 M255 M SLOP FORT af SLOP STD junace 1190 |ULLAGE INTERFACE Tal We [Capaciey BIS we Copsey 23 WP [Water 29.450 NP Water 79450_NP [TOTAL SLOP 52586 WP Loading Mi SLOP TANK’ AETER i i Date. ‘August 4, 2023 MD: AD: 83M 30M SLOP PORT, SLOPSTBD foutace 1188 wer [ULLAGE INTERFACE 127 Wie [capacity 7i2.30__ne Canaciy 213830_w Water 75250__ve Water 729350 MF [FOTAL SLOP #56260 WP ‘This isto certify the above mentioned quantity of slop i towed in tank of my vessel Note: Slop* ean /can't pumped ashore Loading MastPI PERTANINA (PERSERO) NW Sitprnic-uarKeTINS @ TRADING ORECTORATE ga ee ren unriereanunmenaenanat moasoamaaera TANKER TIME SHEET Voud MI. MEDELIN EXPO Pantof—_s BALIKAPAN Net Ret» WACAP Fag donee bate osacustvs 2028 tA. Mater Cpt Akal Voy No O7/DW/Wons A A A 109017 LetPok | MARASSAR [anal _—[--570[ 470-3 70-| 200 45007 77o-|-470-|-370-| 4.00. ‘Statement OF Activity Pros Or oo rz, ar a Os bard or Acer ins Fs Sey cece Esadna tm comma [Gorercd banang [Serene sts Nasa [Fees pacing Conrad Toi pacesing Corp [eonnence Bach [renpray siege Psi Dac [Fsnsieea ser Foss pacing Command Tris zncings Coad [escason Compas [resus a byapao i Pow 8 Cs Onan ona [connecter UFO [saree bert Pec aE [ea te eae a FrGURE SVLNo Date iP Remark Hour PART [TNE O15 1250 oxDE0r fos8. [0508207 [oxoazo: [oxoazo: [ox08 20% [ox 082025 0807 fox 08.207 fosos207 fos 08x f0508:202 (050930; 00105 BORN OHIO 020% AIOE OTOH ROS ae are Tay OT Reply | Om 254 213168 B21 “a9 i Sa ao [ae eae [cr far [ror Te rox eslansion Fen ae ase Pom we [avn USED [fora Tm fs Mase andisoNX ‘CH OFFIPT PERTAMINA (PERSERO) NBA shipping markeTinc & TRADING DIRECTORATE Ss” ‘TANKER OPERATION, PT FERTANINA, HEAD OFFICE 18% Fle dnMeraka Tr tA Jka 0110 Prone 6221)91637 301634, 301633001695 201617, Fa:485(0 201640, 9507121 Ema epstanker@peraminashippingcon NOTICE OF READINESS o7/oIv/vi1/2023 PoRT BALIKPAPAN DATE 02.08.2023 TIME TENDERED 01,00 LT To: PT. PERTAMINA (PERSERO) BALIKPAPAN Dear Sir, hereby tender you the MASTER OF MT. MEDELIN EXPO/ POAO at the date time shown above as being ready in all respect to commence the loading / discharging of her cargo consisting of : Description of cargo ~ Approximate amount/Bill of Loading Quantity MFO 180 +1- 3378.891 KL Lay time will commence as specified in the charter party covering this voyage ACCEPTED Very Truly Yours Date : 03.08. jours: 19.18 LT By MRasib Loading MasterCOMPARTMENT LOG SHEET BEFORE DISCH NR imcorvese ‘AIT: MEDELIN EXPO [DRAFT (mete) —— ay Por SIS MT-CENDRAWWASIH BALIKPAPAN im torno ‘orawanraoes Tat pane Tharey, Ager OF 2025, TANKS OBSERVATION vor reo | narra proto | ‘gee trae) Serscrs7 Er ys7 aa |-0-e0a| —0-seewre| —ero-180) zi z =0as| ea 42668) NIE "ge5{35-5- | 02 ae0sl —o-sesvas] a, 126-139) 64.51 1081-108] SouHn Osr PT. WARUNA NUSA SENTANA (WNS) REVISION #00 | TANGGAL/ DATE | _ 04/2022 = ‘STANDARD FORM SHIPS FILENO: B03 | OFFICE FILE NO: N/A. ‘STANDARD FORM FOP - 222 Page 1 of 2 BERLAKU FORM BAGIAN / APPLICABLE FORM SECTIONS | PERIANJIAN SEBELUM MUAT / BONGKAR AGREEMENT BEFORE LOADING / DISCHARGING FoP Bagian 5.1 Kapal: MT MEDELIN EXPO. Vessel: Polabuhan: BALIKPAPAN Dermaga: STS MT.CENDRAWASIH Port vetty: Kara cargo Kargo? Grade Kuaniias BI. Kuaniitas Kapal | Tangid yang Dimuat Cargo/ Grado Quantity Br. | Quant of Vessel Loaded Tank i_ MFO 180. 3378.891 KL }186.661 KL LCA 2CF SCF 7CA_ i lbiscH ORDER i 000 KL fa Koneksi 2 connection ‘Ukuran Saluran Kargo Kapal | Ukaran ManifoldKapal | Ukuran Selana Darat/ Loading Arm Size.of Vessel Cargo Channel _| Size of Vesse!Manifold__|_Sizo of Lend Hose/Loading Arm_| e lo" E v 7 3 Taj Bongkar Mat? {OO KL/H SKG Kapal /- Darat / Disetujui 3. Loading Unloading Speed Vessel/Land/ Approved JKeadaan Bongkar Muat Loading Unloading Condition aj Waksimum yang ankan [The expected maximum speed fa) Pada tanap awal a) Atte Deginin [70 1G b) Selama Bongkar Muat {b) During leaing unloading hoo Ki7H 5 KG fe) Selama topping up /stpaing le) during topping up / stripping Termination after loading Vessel/ Shore 7 [Penghentian setelah selesal pemuatan - Kapal//Darat HIP Iatximum Pressure allowed in vessel manifold @ [Tekanan Maksimum yang dijinkan pada manifold apal KG Koen @ [Jumiah tangki darat? Number of Land tank? 7 [Jarak Tangki Darat dari Dormaga? Distance of shore tank from dock? 0M @ [Urutan Bongkar Muat: lorder of Loading Unloading: ICA 2CF SCF ICA @ Jurutan Ballasting/Debalast. Order of BallastingDebellast: law Tika dokumen ini diprnt, menjadi dokumen yang tidak dkontrol (uncontrolled).PT. WARUNA NUSA SENTANA (WNS) REVISION #00__| TANGGAL/ DATE 04/2022 - STANDARD FORM STANDARD FORM FOP - 222 Page 2 of 2 ‘SHIPS FILE NO: B03 OFFICE FILE NO: N/A_| BERLAKU FORM BAGIAN / APPLICABLE FORM SECTIONS: PERIANJIAN SEBELUM MUAT / BONGKAR ap eee AGREEMENT BEFORE LOADING / DISCHARGING 10 [Kedalaman ar Winmur a dermaga Take Wei? 0.2 [Dept of minimum water in dock’ Maximum im? 11 |Sarana Komunikasi dan telah Di uji CH 09 Communication facies and hes beon tested 72 [Prosedur Emergency Stop [Procedure of Emergency Stop J) Mengaktikan emergency stop pompa kapal /darat YA la) Actving emergency stop of vesseland pump lo) Menutup manifold kargo kapal YA lb) closing vessel cargo manifold Je) Membentuk komunikasiantara kapal/ darat YA lo) forming communication between vesselshore 4) Mengambil langkah -langkah yang diperiukan YA le) Taking required steps ¥3]ain-tain: lothers: Untuk Kapar Untuk Darat For Vessel For Shore Nama NOISOLIIN = MeRasi [Jabatan [Position [Tanda Tangan Signature ra 7 oa pate | 03/06/2023 rt * coret yang tidak perty Mengacu pada Ship / shore safely chekst * strike the unnecessary In accordance with Shipboard /shore safety checkist eps Tika dokumen ini diprint, menjadi dokamen yang tidak dikontrol (uncontrolled)PT. WARUNA NUSA SENTANA (WNS) REVISION # 00 TERBIT / ISSUED 04/2022 L STANDARD FORM. STANDARD FORM. FOP ~ 233 Page 1of2 _ SHIPS FILE NO: AQ1 & E01 | OFFICE FILENO: N/A | BERLAKU FORM BAGIAN / APPLICABLE FORM SECTIONS | BERITA ACARA ERP Bagian 1 Sub Bagian 7.1 STATEMENT OF FACT FOP Bagian 5.1 Sub Bagian 4.30 Nama Kapal , MT.MEDELIN _ Kiasifiasi + BEI ‘Ship's Nome * EXPO Class . No. IMO Nama Manajer noe 9062702 TATE. Br wns Pelabuhan : Subjek _ Kondisi laut & alat ukur eee 1) BELAWAN Subject * saat Ullaging Tanda Panggilan No. Referensi ase POAO mca + EXPO/07/D1V/03/08/23 Tanggal | Waktu Keterangan date_| Time Description | Pada hari ini,Selasa Tanggal 03 Agustus 2023 Kapal MT. MEDELIN EXPO sandar di STS MT.Cendrawasih dalam rangka kegiatan 03 16.48. | Bongkar/Discharge MFO 180 sebanyak -/+ 3186 kilo liter dengan cuaca Agustus | 17'4g | disekitar Smooth pada saat di adakan pengukuran, sehingga pengukuran 2023 ° di ambil Tiga kali setiap COT. | Fix Figure untuk R2 =-0.01 % yang di gunakan adalah hasil kesepakatan | bersama Loading Master, Surveyor dan pihak Kapal - _ Alat ukur MMC yang di gunakan dengan no. seri 7040 (UTI Meter) | - Kandungan Air dalam COT Nil | -Perhitungan menggunakan Density Loading Port : MFO 0.9608 L Pengambilan Sample bersama pihak kapal untuk setiap tanki Dengan ini menyatakan bahwa keterangan diatas benar dan dijelaskan sesuai dengan sepengetahuan saya. This is to state that above mentioned is true and correct to the best of my knowledge. “ka dokumen ini diprint, maka menjadi dokumen yang tidak dikontrol (uncontrolled)RUNA NUSA SENTANA(WNS) | REVISION WOO | TeRDIT/iSsUCD | o4/2022 STANDARD FORM STANDARD FORM | FOP ~ 233 Page 2 ot? “SHIPS FILE 01&£01 | OFFICEFILENO:N/A | BERLAKU FORM BAGIAN / APPLICABLE FORM SECTIONS BERITA ACARA ERP Bagian 1 Sub Bagian 7.4 STATEMENT OF FACT FOP Bagian 5.1 Sub Bagian 4.30 Tanggal/oote: 03 Agustus 2023 Nama Saksi Warey (MRasib) “ka dokumen ini diprint, maka menjadi dokumen yang tidak dikontrol (uncontroved)PT. Waruna Nusa Sentana / POK CATATAN LAJU BONGKAR / MUAT TIAP JAM [Nama kapal:_ | MT. MEDELIN EXPO |Density: | 0.9608 Jumlah Nominasi: 3000 KL IKargo: | MFO 180 Novel. JovpiVvivivo023 — [Tange peos.2075, [Dermaga: STS CENDRAWASTH [BALIKPAPAN Hours | Pana | een) | __ Discharge Tank as TER SCE IER B00 co TERS TCA a0 3 TC, SCE TCA ato TCH SCHTCH 00 3a TCR SCR-TCA 00 3 TCA SCR TCR ot0 a Tha 50 TA AF 760 208 TCA. 700 7m 2 00 2 BE agian [Discharge Agreement Shore] Vestel Capasi fTekanan max Manor Kelem_| | Ky/em fax low Rate Kijam~[ 400 | -Kijam jumlah Line & Diameter inches | 1/10 [inches ‘CATATAN: MASUKKAN FILE INI DI BIT Halaman 4 dari 4 PoK-231 REV o1/Feb 2016BUNKER LOGSHEET M® PERTAMINA surone oscunsat fan er oe a] ‘DONKER FREERBUNKER LOGSHEET r PERTAMINA AFTERDISCHARGE [ovoerane woot prowam VAN. cUMENT NO ‘Stoner se gods bare lon are rut ARCMIN varcow taux | crtoe [—actuat [comers] onserven” conmscron] comacron] racron | voLeannet awe cuuacernoact | uurcernmace] vor mnt | Hes /ust owt fon oot ~ trot | to at) ‘SETUNG seve 70 re SEE DUNE OFFICER cher ENGIVESSEL'S EXPERIENCES FACTOR ( VEF ) P= ee ee ee] mee eS eS 2 Jus. BARREL AT eo | zaazs | SACP [o5.107200| eszesee] iere0] ore) a a ea cal ae aot et ot ot pe ee} sat of ara oe ee SS Sas fem sa | soem SL ee mel ose et ee st es a Stee SS SS ee Somer] | ooo | =|23 col eales| See pe|__were—_[vorone]| ror [a [ae Co “Tos BARREL AT 60°| 2aoarz023]} S™ACAP [os saa210| o5.114ceo] 20200] oa) Seems) os] ___ [saat ao el lal ol ott oe ? ies eanner aren 2uannza | AN 95.149:210] 98114980] 28230] 003} sa2sa5a4] 128854] 0:13] 11.447.006| ex.or05z3| eaensace| 215417 026) sare] onal mesos |__| Sf eet et Se ace ere eel sel ool el oe he BARRELATEO| erzoes | VAAN seosacs| ssorosza| 215.117] a2e] easet75| 1.192] 006] 19327421] es.ataet7| ea.87ses| _soasa| oor] axser| oz} Ese] se | Pr nem eat | et pe er Senta ool s Jus. earner arer| eurzozs | TSS°R*M [Ge 67005] eaareat7| soasa| oor) onssar7e| arias] oaol 36,960.03) 31,340.567| 31,379.052| 29.485] 009] 51278] asi] mes] ey Pt nl aes af ee Sa meno anes eel * le eannecaree] tauaazs TEPROK | 4 79083 31,340867] 20486] -o00] 3130534] 18777] 005] s1a08as0| 2000] 0.000] 0000] sow] seor4| 0.18) -70622 007} fel wwe [vorowe] rote om reo _[Domrai)inna| an [oro | ewer hae See loreR oes ‘soize 1ease.czs) Yeaa7 200) ssaczso7| s02si| 025] ascasei| vis7e700| saseacca] eres] aaa] eara] oa] vse) 70 Us eamner are | 204023 oazs0ea0) osresn7| exsresre] reer] 0s] aesrrani| roxerseo] carzaaial essai] oer] asefrances] oscoms [| maa ral eS pecone Te zuco caro] Tara razon] wan] one sswran| aaa] —soraan| ara] on] aoe] oa prewons | conan, esas cootse| — eas|_evo| cams] oon] oon] eam rove] ann] “ood aaa] Josennact arom] ncaa | “AS 38,184806| 30,462.243] 9481605] 1s.4ss] 0.05] 39,496.239 0.000] 9.000] 9.000) worvo:] 45.480) 0.12] 201.432] 0:30] wre [rovowre| pear | | wea ORT [SRT] ro mm | eee fremcas ——[canzs puny | wears] ren oc] oo Jus. sanret ar 6o| aowanzs | S"ACAP ["ssegaa0o| sasiesve] 21988) 025] frexens [ora |, [sera soarec] ovr] on] vaeinal —ovaa) an] aaa] name] naazal aasa| va] anal oa femme] sna ee a a | frenens —[ounams [| rma) vice] sma] of vaoran] aan] em] onvon] tren] romee] areal Taal meet ao Jus. earner ator] avrranzs | Ceseewasih V7, sooezs] 71sese0| 164360] 023) Trsae% -29007| 004] 024.873) 10.587 880] ro47594e si s11| 08a] -«s.45i] 0.05] frees osacs |, | ssn] szeseu] ran sav]_sanen] oss] son] ven] oon] cow] a ovo] aren sea sasat al Pewee] enms caarea] worse] oon_ow| vase] aason] wx) wsaze] oon] oon] aml rovo| aameel soal want oaP.T PERTAMINA CPERSERO ) fs” then 209 SAS SHEP _E-mash epstankendipertaminmsbygyang com TANK INSPECTION REPORT (BEFORE DISCH) PORT : BALIKPAPAN DATE 03 AGUSTUS 2023, voy — :07/DIV/viI/2028 |, the Master of MT. MEDELIN EXPO / P.O AO, have inspected all ship tanks ats 16.48 9/4 17.48 Hrs and found empty and suitable clear. Remark porT CSB Empty ship tanks: COT# dias ler Ena. © 10 TANK 2] emery EmpTy PS 18 TANK EMPTY [ener [ewery [enor TOTAL 26 TANK EMPTY | EMPTY | EMPTY 4) EMPTY EMPTY, ‘EMPTY, EMPTY, 5] EMPTY ECrAEO) ‘EMPTY EMPTY 6) EMPTY EMPTY, ‘EMPTY EMPTY 7| EMPTY EMETY! EMPTY MFO 180) To: Master MT. MEDELIN EXPO / POAO We confirmed acceptance dty certificate at _ 17.48 hours local time on, 3-Aug-23 aa Masi Fah LOADING MASTER ‘SURVEYORPT PERTAMINA ( PERSERO) SHIPPING - MARKETING & TRADING DIRECTORATE ‘TANKER OPERATION, PTPERTAMINA (PERSERO) HEAD OFFICE 1th Flo, Mele Timur 1A arta ONO fs" thon er ese sn oss ah eptnkentpertominvtppng com TANK PORT CAFTER DISCH) PORT : : BALIKPAPAN DATE : Friday, August 04, 2023 voy; :07/DIV/vil/2023 1, the Master of MT. MEDELIN EXPO / PO A O, have inspected all ship tanks at 15.00+ s/d 14.00 Hrs. and found empty and suitable clear. Remark Port c__STB Empty ship tanks pty ship tanks: COT # curry EET cary EMPTY, © 3 TANK EMPTY 2| emery eMPrY PIS 10 TANK EMPTY EwpTy | eMpry | EMPTY TOTAL 18 TANK EMPTY | EMPTY | EMPTY 4) EMPTY EME. EMPTY EMPTY a 5] EMPTY Bae, EMPTY EMPTY 6) EMPTY SPT’, EMPTY, EMPTY 7] empry LEMPLY EMPTY, EMPTY To: Master MT. MEDELIN EXPO / POAO ‘We confirmed acceptance dry certificate at 14.00 hhours local time on, — 4-Aug-23 LOADING MASTER ‘SURVEYORPT. Waruna Nusa Sentana / POK pS WARUNA — sceneucarsior Shipyard Shipping (BEFORE DISCH) Untuk pak yang berepentingan, Date 05 AGUSTUS 2025 Kapa 2 ME-MEDELIN EXPO Nama Pelabuhan 2BALIKPAPAN No, Pelayaran LOZLDIV/VI20.23 Nama Terminal ST ME-CENDRAWASIH Pengukuran Slop Tank, Nama slp Tank PORTSIDE STARBOARD SIDE Temperature (F) APL. Gravity pada 6OF lage Interface 9,868 mm Kuantitas Total slop 11280 KL 15,906 KL Kandungan Air 570 KL 10385 KL Kuantitas pada Residu : 6110 KL 3520 KL Har ini untuk menyatakan bahua sep tersebut dats telahdisimpan di Kapal pada sat bedatangan di Pelabuhan ii SURVEYOR TOADING MASTER [EATATAN: MASUKAN FILE DIBO1 Halaman 1 dan 4 PoK-232REV One 2016PT. Waruna Nusa Sentana / POK Shipyard Shipping CAPTER DISCH) ‘Untuk plhak yang berkepentingan, Date aAug-25 Kapal ‘ SHIPPED in apparent good order and condition by .. on board to .ANDONESLA. 1 2 where of CAPTARMAL wis Master, the por of. e 3 [Lay BBE m bo ad w be dre (aie ele, dios, oslo Ga Rana i ‘hereinafter conditioned) in the like order and condition at the Port of ~~ REROT.TANIUNG.WANGI. me = ieee Sr so ner threo a she my ately get andthe doce 2 unto CONSIGNEE ; NA PATRA NIAGA. MOR V -SURAI 7 8 9 10 “QUANTITY and GRADE. AS FURNISHED BY SHIPPER: a = Mro-18001FO1— Long tons - 13,802.98 Metre tons 14024899 US. Barrels @ 60°F 97,982.050 Liters 15°C = 14912532 Liters Observed = 14,999,602 Density °c Fasen, Temperature °C =a Equipment Custody Trane 7 ech “Wise ris impreta atc intake quant bet i ‘of aig i sige he quant should bested scapes Weight, quantity, qu: grade and condition unknown, Vessel fot accountable for u sakage 2 ‘Ths shipment is eared under and pursuant totems ofthe cha died 3 : ee 5 1 1s 4. vn - 6 44 all the terns whatsoever ofthe said Chaney ‘ tad gover the righ ofthe pate concemed in thi p Fright shallb deemed ob enmed on commencement of loading i ar ti pueetsNe an, Teves the Till of Ladne a jaan hein and. fm 1 of thie Bil of Ladin a IN WITNESS whee ofthe Master ofthe sid Vessel hath affimed to (0x) n Xf Laing of this tenor and de one of wich ting ao voi 1 Data. sex, Refer Unt hte sen tye 7 Lemans (in 021 aa aha T2316, 482TH Hate Sian 4d. SMDaa Bosuevey Soe wen radentol RECEIPT OF DOCUMENTS TO: Master / Chief Officer Veesats Name ' ar MBM EL y..B%PO- nponsttntan Port Terminal 7. Aes. MTC EAA MARAE HE Product / Cargo Date 7 Kindly acknowledge receiot ofthe folowing documents : DocumeNT ty Noanaton Reno “Tans nspecton Repo Vessel Ue, : Shore Messuement Report a a Reper Ro And 080 Report ~genelng Ae Songs Resa macro ain ss nnn arta trate rut sl ie mean sma oh note ena sharers sees sain amoo ASSN TS ewan mts tac Sr asaya ie sean neste aoeY iDSurvey 2 <> FIGAsO3-02 QUANTITY NOMINATION REPORT MAT: fireeeuny expo: AQPO = Hy: fts_ zp In conennusaet: |" ox-oy Airectrut: +3 “The partes as sated below Chit Oe aR do, 3. Cargo Sunveyor fePeas lave agred to load he cargo. NGPO NIB ooo by he loving manners: 1. Thenominted quanty to beleaced was ..2t...g fe Bb ME 2. Master ofthe vessel requested toload .. WZ... 3.270: cabs ba andloadngraels..f.. Yoo". Bes GA howatho pacar. 7... Clb? Lege? Terminatlading rate ZY. C1Bbls 7 hou ‘The wansleris tobe siopped by MP. ApBABLIAL...Prypo: Sioagealcaiga. 2. RO PE~ En. Detinaton.... Orbs ean Remarks ‘rte aust mney aby, vm dd ae eg te "seam crewnthcmnaaaies pialg iDSurvey FMIGASO-03 ‘TANKS INSPECTION REPORT (DRY / EMPTY CERTIFICATE ) ~=— - or Lo Meee CD Ab Pot oro LTS BERL MIP BcaLtTOAUIAE Hf Orn~oy ‘Abug7us devs “Tht cert thatthe undersigned Surveyor having inspected the rg lnk no: ([Porr. _. Of the above vessel fom deck level and have been found. (2 BEFORE DISCHARGING D BEFORE LOADING Dry, empty at time and place of visual inspection, Ory, empty at time and pace of visual Inspection Indcating ship's tanks) isnot contain the cargo. and ready fr loading intended carg. Exception : (@-FFTER DISCHARGING Wel-tiped empty, incstng tat al the cage tad been dschrgd thou Exestion: / FAC ot PAC BPA YPES TPO 67m e FFAS TPIS: B18 SPARE JORIS CPS FRE ary {Quantity of unstipped bales water in carga tank bottoms and cargo pipe line after completion of debalasting is unknown Measurement taken at ulage J nage gins / cotral room pane indicated that tanks were apparendy empty ( Please refer to ROB / 069 Peper ) ‘Sigs pump and lines were mspected at acessible ponts and found to be vistiy clean at tme and place of visual ipo The prev cargos eared and a8 me . Crancno DREVIOUS CARGO | [Fianicno | ~~ previous canso { analg IDSurvey VESSEL ULLAGE REPORT Geter 0 Aer 0 Losing B-eschai9 sage uae actos etter pene Ae ATED: SAA nes ime )/ (805) was “(iy (60s [are ©" (Gils at 60) eS (oP / (B08 J: ina i eee icity al [Metres wt) oar TABLE astN | TT GEMTRa Scio bosaooe (Tae) Cage | GUMTR at 18°C 0 Lorg Tors (Table 57) uM st 1S'Co N= |. Barrels at 60° Delivered / Received BEFORE% eS FMIGASO-08 g IDSurvey TANKS NOT USED AND VESSEL VALVE SEALING © ForLeading EF Dis _ [Pair Anéacun EAPO: Maro to LTS_APR Ayr CMR RULER hN Ot-oy sGugeus Hevt. BEFORE B@ADING/ DISCHARGING orart | $7) TANK NO | dor/s: 2 wing _C Vessets Valve Seating lage inna a | ‘nig {ie of 7) “otal Alter Leading Disha f | Pret t6 commencement of loading | discharging the folowing valve(s) are noi used for loading] DESCRIPTION _fuischorgingoperaton and were sealed inthe presence of terminals / vessels "| [tepeeratier [Vessets Valves | vovensuenvavescnvesvavesd csssesesseesan [ Seal Number { J |g IDSurvey onan 10 NOTICE OF DISCREPANCY To: Master! Chief Officer Terminal Representative Vessel's Name Pott Terminal Product / Grade Date (On behaif of our Principal, we hereby bring fo your attention tothe Bil of Lading Figures against the Vessel’ / ‘Shore Figures diference noted at completion of Ulage Before Discharge Calculation / Discharging / Loading of the above named vessel \We set down Ullage Before Discharge Calculation / Discharged / Loaded dotal bellow and reserve the rights of ‘ur Principals to refer to this matter atthe later date, should they deem it necessary inthe event of a clam KL at 1580) Bots at 00% Long Tons Metric Tons, BialLadng/ Ship Faueso > 2.46 ; Shio's/Shore Figues AL ieee na Diference Percentage YY Remarks 2pm measncnorencegy iDSurvey “&S” MGAsD 12 TIME SHEET Lor bpereun Spo Ls Been: pir: ObeR AULA EVENTS. Notice of readiness accepted ‘Sailed (Estimate Time Departure) Aiur 20), Abrudres $73 Adusres +18) Dalays / Stoppages / Remarks L ae tae ete cacana enfants ebes ocr von ee Ea ar EMRE insandlctaa save necseclewn em oangm IDSurvey SURAT PERNYATAAN SURVEYOR SEBELUM MEMULAI PEKERJAAN Berdasarkan instruksi Pimpinan PT Surveyor Indonesia Project Cargo Monitoring serta untuk ‘menjaga Independensi Surveyor PT Surveyor Indonesia di seluruh lokasi Kerja PT Pertamina Persero, ‘Maka saya yang bertanda tangan di bawah ini. Nama Lengkap VFAHRY Proses + Loadiig / Discharge / ROB” No. Hp 1 O85 2SSEISI'D. Jabatan/Lokasi Kerja + Leader Surveyor / STS GALIKPSPAN Nama Kapal /Tanggal Kegiatan/Jam : wf. WEEN EPO 08 /08/2023/ LT Menyatakan dengan sungguh-sungguh bahwa : 1. Saya menolak segala pemberian, baik berupa uang atau bentuk lainnya sekecil apa pun, dari pihak-pihak eksternal mana pun yang berhubungan dengan pekerjaan saya. 2. Saya menolak ajakan entertain pihak-pihak eksternal mana pun yang berhubungan dengan pekerjaan saya. 3. Saya menolak untuk memanipulasi/merekayasa data-data hasil pengukuran dan juga memanipulasi/merekayasa perhitungan dan saya juga tidak akan menyetujui tindakan tersebut. 4, Saya menolak untuk melibatkan diri atau mengajak untuk bekerjasama dengan pihak-pihak eksternal manapun yang berhubungan dengan pekerjaan saya untuk melakukan fraud demi keuntungan pribadi atau kelompok. 5, Apabila saya terbukti melanggar salah satu atau seluruh poin di atas, maka saya bersedia di PHK oleh pimpinan PT Surveyor Indonesia Divisi Bisnis Migas dan Sistem Pembangkit dan bersedia menerima konsekuensi hukum sesuai aturan hukum yang berlaku di Negara Republik Indonesia. Baliepapon og /oR, 2023 Surveyor Terminal Representative NOTE: Copy surat peryataan sudah diterima Vessel dan Terminal Repsentative, Pr Surveyor Indonesia & (e229 s255526 Gana survey Indonesia @ (22) 255526 Lend. 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