CARSU Rf N Quatitv with tntesritv

I C6.r I Mrnral.l LrDo..tD.y tcadng

IOrl&G.s,ti..im I rn .i.re Ofsr!o.! I rttDLom I c'!.rnt

ts I C.r9o I Agri.urtrrE I

lq/ds Ag.i!

TO:
THE MASTER / CHIEF OFFICER
MT. SICHEM MONTREAL

VOYAGENO:
LOADPORT

35

PULAULAUT,INDONESIA

DATE: JUNE 12,2016

MASTERS RECEIPT OF DOCUMENTS

DEAR SIRS,

KINDLY ACKNOWLEDGE RECEIPT OF THE FOLLOWING DOCUMENTS

2.
J.
4.
5.
6.

7.
8.

9.
10.

ll

NUMBER

DOCUMENTS

NO
I

FOSFA HEATING INSTRUCTIONS IN RESPECT OF

BULK SHIPMENT OF OILS AND FATS
FOSFA COMBINED MASTER CERTIFICATED
FOSFA CERTIFICATE OF LAST THREE CARGOES
FOSFA CERTIFICATE OF COMPLIANCE, CLEANLINESS
AND SUITABILITY OF SHIP'S TANK
MASTER'S / OWNERS CERTIFICATE
CERTIFICATE OF CLEANLINESS, TIGHTNESS AND
FITNESS OF SHIP'S TANKS AND CONNECTING
PIPELINESS/HOSES
CERTIFICATE OF TANK INSPECTION
SAMPLE RECEIPT
ULLAGE/SOUNDING REPORT

TIME SHEET
NOTICE OF APPARENT DISCREPANCY / LETTER OF
PROTEST

ICOPY

I COPY
I COPY

COPY EACH

TANK
I COPY

ICOPY
I COPY
I COPY
ICOPY
ICOPY
ICOPY

ACKNOWLEGDE RECEIPT BY

6.i?,')A

TO
VESSEL
VOYAGE NO,

THE MASTER / CHIEF OFFICER

MT. SICHE|\il MONTREAL

DATE

JUNE 1,1,2016

FOSFA HEATING INSTRUCTIONS IN RESPECT OF BULK SHIPUENT OF OILS AND FATS

QUANTITY/COMMODITY
STOWAGE
LOADING PORT
DISCHARGE PORT
SELLER/SHIPPER
BUYER/NOTIFY

1-

Shipp6 slallensE
handled

2.
3.
3.1
3.1.1
3-1-2

:
:

:
:

TRACEABLE PALM FATTY ACID DISTILLATE IN BULK

.9l tt94F--o..nE..........

.PI. 99L,.,q_E.N.!].9i_E..!!p.941.r.I4RA. .

:
thal the

2P,25,3P,35,4P,4S
PULAU TAUT, INDONESIA
.

NESTE SINGAPORE PTE LTD

hpsalurc ofth.oil duingdetive.y

inro

fi.lank(9 ofdle

ard wh@ tear is appli.d thal fte r.opqdue in m cs.

ship is thar ar which O

rLar

oil u$ally

8ivfl in th.

appropriarc table.
Matq shall supply to @go r@ivers a nalm@l showing the c&go t6lnp.rdE al loading ed a ch.n on which the daily
rtrpdrru* aftd l@ding havc b.n l!d.Ld. Th. chdl .h.ll bc ;sncd by dE maid d authmi$d otrcd.
Shippcrs sh.all supply $e following inslruction! wih regdd ro hea ng of oil during lhe voyage:
Shipt tlnl(s fitted wirh tearing coils.
On completion ofloadins" ship's coils slsll @mpleiely @vetd with oil.
Hering sh.ll b. eff61d by hot e6rc, or, *hft rhis is irplactisble, ty low pt6w saiuard st.atn. Prc$E shall mt

decd

3.1.3
3-1.4

M]

L5

exceds

bugalge

3.1.5

fie vorge de oilsltall be maintaincd i! a@rdfilce wilh the ranpraturc st oldin lfie Heatina Rcommddatiotrs.
ln sullicial time p.ior lo dival al pon of di$hage" hal shall bc applic.l gmduajly to 6re tbat th. tcmFr.tue ofl[e oil
at lim. ofdi$hdge is in a@rda@ wilh th. tmperatlB eloulin lhc He5ring Rqx)lm6dations Thc.5rgo slDllbe
@inr.ircd wiihin dris @Be of rmpoducs inronglour the dis.hargc.
ln ord.t to avoid @y (hnas.lo th. quality of the oil, it is Mtirl
thal hal is applied gndudly. A eddm itr(rc in

3.1.6
3-1-7

Thc inctte in temp@turc of th. oil durins ey pdiod of 24 hours shall nfld dceed 5oC.
A3 fd a ptutibl., top &d bottom t mpfttuGs slall b @inraii.d ar cq@] icvcls; tnc diffc@@ b.tw.m rhe* two

DudnS

tempemlurc musi be avoided

icmpciatures

3.1.8
a.
b.
3.1.9

i)
ii)
3-2
3

3-4

$ n wil alm6t 6iai.ry 6ult ii

slull rcvd dced

danage ro lh oil.

soc.

refeftd to &!ovc.rc the avemse oftop, diddle and bonom @dinsi The rop re3dint s}'all be tal@ ar
abour 30cm (orc f@t) bolow ih. surfa., of lhe oil. Tho boflorD Hdings shall be laki:
ln t4ls which have boitm @ils al 30cm (one [ool) rbo! the lael ofrhc coils.
ln r,Iks whict have si& @ils bui tro bonm @ils at a point .bdi reo fer (6om) fioE dE bonom of thtak
ed rbout 30m (one f@t) Aom lnc sid. 6ils.
Th. tmp@rE itrdi.atd in 3.1.4 abov. d. applieble ud oomd condirions oling ar porr of di$hng.. ln rhe evor of
abnoE al mditioos (such E exlt@.ly lN air G watd tmpnatms) reciv.rs, eilhs dn@dy or lhrough lheiruppointed
representotives, may vary rhe Iorpcraturcs stated ed iBtruct ship oMers or then agan accordin8ly. D.iaih of ey sucl
vuiatims shdl be duly @dcd od advis.d io shippss or iheir repr.eiatiles. lf the@ is mor than one r.ivq of the oil
c, one shipt t n* !
Allr@iveBfom tlat tark should b. itr.grdnot io tbe prcposed vdirtions in the tmpoatuB iarcd in 3.1.4 abole.
Shit'p.r's r.?ffiLlir.
.l !o.l of dilchdg. JEll @d.avN 10 tEmil. r.quit@als of th. individlsl lwiv6
Fd brks with h@r qch.rg6
All ilnEcrids mdd pdasraph 3.1 e rpplicable qcefl i.l.l dtd in 3.1.8; the bonm tmpdalu. should b. tal6 30or
Thc tcmpcmntres

(on. fooo abore lak bottom.

Bulk Oik noI lomally.qui.iq hatirs duirs the voy.se
Ifit is.nvisged that the temperature ofthe oilat the ane ofdischarge will b. below fie minimun figure indicated in 1he
schedule, the oil must be heated not lnorc tle 5oC per 24 hours until the @quired di$harye Gmperature is.eached.
Bulk oils shipped in taks by

vesl who*

voyages by

or

inldd watNay

do nor

sced

5 days

The oil mun be loaded at a Iemperalulc which will emble the di$harge temrrar@ to be rtlched
of the oil by not more fim 5'C per 24 hours

by raisinS the tmperatde

FOSFA Hf ATING RECO]U]ITENDATIONS

COMMODITY

TRACEABLE PALM
FATTY ACID DISTILLATE
IN BULK
1

2.
3.

4.

Temperalure during voyege

Temperature al time of loading & discharge

Minimum'C

l\,,laximum'C

Minimum "C

45

50

55

Maximum

'C

72

The maimum tempralure specifred dunng the voyage is loyrer lhan lhe minimum required for dischalge, in some cass by as much
as 150 C. Eeadng in mind the stipulaton contained in paraEph 3.1 .6. il should be cognized thai jn some cases ships offcers wll
need lo apply heat a few days pdor to arival in order lo reach lhe appropdate discharge lemperalure.
lt is recognized lhat in some cases lhe ambient lemperalure may exce6d the recommended maximumigures shown in lhe Heating
Recommendalions.
Hydrogenaled oils csn vary considerably an their slip meltng points, which should always b declard. ll is recommended lhat d uing
lhe voyage, th6 temprature should be mainlained at around lhe declad mehing pdnt and that this should be increased pior to
discharge lo give a lemperature of blween 1 0o C and 1 50 C above thsl poinl to effect a dean dischsrge.
Oirerent grades of palm sleann may hava wide vsdalions in their slip meling poinls and the lemperature quoH may need to be

lssued by

FOSFA GOMBINED MA$TERS CERTIFIGATE

Ship

MT. SICHEN4 MONTREAL

Built 2008
owner r EAniJA-r,lk-EHSctlYcrAESlio
Year

rn r.espe-ci

o?iii,idriJoi

r'iffi;!;i-

Loaded/Ex Transhipment

at

Voyage
Official

No 35
No'iiArv
740612

lArrki-RS ctiV CUSSTiii-operaror --lRAceeefe_f[t{fAfjY_A_cf_o_-oiSrtt

____-:_________________________. oescriptton
PU_LAU_LAU_T_, IN_Dqry_E.S-|A_________-- For shipment

(Load

Port)

to

rnrr

.-S.ll!93P-_O3_E_________

(Discharge Port)

lnShip'sTanksNo(s)-__-_Z?I_S_,_3_Pr9_S_,_4_EI_S_

Shippers/Charterers
I

NESTE SINGAPORE PTE LTD

state that
The above named vessel is classed with
IOU_ST-oN,-US4.........date.l4AY-1-3]-2-91-6-.
(society) _-__A_B_S__-_---__- Certificate No ._09!!lf!?_----_--__-__.lssued
which currenily remains in force. The oil tight integrity of all the cargo compartments is a condition of such
classification.
The named ship complies with lhe FOSFA Qualifications and Operational Procedures.
Tank heating is by.immersed coils/heatxhas. Coils, tubes and shell as applicable are ofstainless steel
period of
(date) to not less
Jq]!E l-1_,_?_O_1_q
construction, and were tested on
-20_-__,Kpa bars for a
2-9_MlN U-TES-___- and found tight.
Copper and its alloy such as brass, bronze or gun metal are not present in any part of the syslem inslallation
and means ofkansport that has contact with the oils or fats.
Tank access/cleaning hatches are staunch and tightwith suitable packing and gaskets compatible with the
cargo.
All internal structural members are selfdraining.
Tank(s) is (are) -miH{eeymild sleetga /stainless steel construction.
Where applicable tank coating(s) is (are) ____-S_MIES_q_9I_E_E-|:____--- which is (are) fit for food grade
products/carriage of oils and fats.
*hst-waler, steam.
ln the tanks heating system, heating medium is
purpose,
if the vessel also has a thermal heating fluid system, the thermal heating
For contamination cont.ol
fluid is NOT APPLICABLE
Cargo lines are "stainless steel/fril+ sleel with sufficient drain valves to ensure complete clearing and
draining of the system.
The tanks(s) has (have) not contained, as the last three cargoes, any leaded products.
The three previous cargoes were as follows :

1.

2.
3.

at

than

4.
5.

6.
7.
8.

9'lO.
11.
12.
13.

2P,25
3P,3S
4P,4S

14.

15.

CARGO

SECOND LAST
CARGO

THIRD LAST
CARGO

MOTOR GASOLINE
MOTOR GASOLINE
RECOATED

FISH FATS OIL

RECOATED
RECOATED

RECOATED
RECOATED
RECOATED

IMMEDIATE PREVIOUS

SHIP'S
TANKS NO.

ln each tanksthe percenlage ofthe immediate previous cargo was not less than 60 percent by volume of
tank.
Subject tanks have been cleaned alter immediate previous cargoes using cleaning methods as noted below:
BUTTERWORIHING WITH WARM SEA WATER (60"C) FOR 1 HRBUTTERWORTHING WITH AMBIENT FRESH WATER FOR 20 MINUTES.
DRAINING OF TANK. LINES AND PUMPS.
MOPPING AND DRYING.

.
-

Subject tanks were/were

Signed

Ship

MT.

Date:

JUNE

'11

2016

prior to loading.

tr.:

eurx

MASTER'S STATEMENT

Ship
Year

MT. SICI{EM MONTREAL

Built

2008

VoyageNo 35
Official No 740612

OwneT TEAM TANKERS CITY CLASS LTD

Operator

In respect ofcarriage of(tonnage)

Description TRACEABLE PALM FATTY ACID

DISTILLATE IN BULK

Loaded/Ex Transhipment

TEAM TANKERS CITY CLASS LTD

at

PULAU LAUT INDONESIA For shipment

(Load Port)

ln Ship's Tanks No(s)

2P,2S,3P,35,4P,4S

Shippers/Charterers

PT. GOLDEN HOPE NUSANTARA

to

SINGAPORE
(Discharge Pofi)

NESTESINGAPORE PTE LTD

I certiry that on the FOSFA List of Banned

Previous Cargoes in force at the date of the Bill/s of LadingEthylene Dichloride and Styrene Monomer were not caded as th three prvious cargoes in organic coated tanks or as the last
cargo in stainless stel and inorganic coated tanks.
The abovc-mcntioned ship's tanks have not contained any leaded products as their three previous cargoes carried, stated to
have been [see conesponding FOSFA Combined Masters Certificate, clause l3].
The immediate previous cargoes in the above-mentioned tanks were not subsiances appearing

The immediate previous cargoes in the above-mgntioned tank were substances on the FOSFA List of Acceptable Previous
Cargoes in fo.ce at the date of the Bilys of Lading.
Ethylene Dichloride and Styrenc Monomer werlj not carried as the three previous cargoes in organic coated tanks or as the last
cargo in stainless stel and inorganic coated tanks.
The above-mentioned ship's tanks have not contained leaded products as their three previous cargoes carried. stated to have
been [see corresponding FOSFA Combined Masters Certificate, clause l3].

Applicable to mild steel tanks only -The threo previous cargoes wre oils and fats for edible and oleo-chemical us and/or
molasses and were stated to have been [see corresponding FOSFA Combined Masters Certificate, clause l3l.
For stainless steeltanks or tanks Iined with epoxy resin or technical equivalent (oils & fats are to be further processed and
intended foror likely to be used for human consumption), the immediate previous cargoes transported in the tanks were
foodstuffs or cargoes from the EU List of Acceptable Previous Cargoes in force at the date of the Bill/s of Lading.
For ship's tanks ofmaterials othcr than those mentioned- above, the three previous cargoes transported in the tanks were
foodstuffs or cargoes from the EU List of Acceptable Previous Cargoes in force at lhe date of the Bill/s of Lading.
For oils & flats which are not to be furthr processed and which are not intended for or likely to be used for human
consumption and which are transported in stainless steel tanks or tanks lined with epoxy resin or technical equivalent, the last
three cargoes transported in the tanks were foodstuffs.
Erhylene Dichlo de and Styrene Monomer were.ot canied asthe three previous cargoes in organic coatd tanks or as the last
cargo in slainless steel and inorganic coated tanks.
The above-mentioned vessel complies vvith the EU Directive (relating

to the transport of bulk liquid oils & fats by sea) in

previous
Bill/s
The
three
cargoes
were
stated to have been [see corresponding Combined
force at the date ofthe
oflading.
Masters Certificate, clause l3 or list ofprevious cargoes supplied by vessell.

DATC JUNE I I 2016

Remark:

*Delete which is inapplicable

* Captain/ChicfOfficer

FOSFA CERTIFICATE OF LAST THREE CARGOES

TO WHOM IT MAY CONCERN

VESSEL

MT. SICHEM MONTREAL

PORT OF LOADING

PULAU LAUT INDONESIA

DATE OF LOADING

JUNE I

SHIP TANK NO

2P,2S,3 P,3S,4P,4S

CARCO

TRACEABLE PALM FATTY ACID DISTILLATE IN BULK

DISCI{ARGE PORT

SINGAPORE

REPRESENTING

NESTE SINGAPORE PTE I-TD

2016

WE CERTIFY TTIAT :
THE IMMEDIATE PREVIOUS CARGO IN THE TANK(S) RECEIVING THE GOODSOF THE CONTRACT
DESCRIPTION WAS NOT A PRODUCT APPEARING ON THE FOSFA INTERNATIONAL LIST OF
BANNED PREVIOUS CARGOES IN FORCE AT THE DATE OF BILL OF LADINC . THE TANK(S) HAVE
NOT CONTAINED ANY LEADED PETROLEUM OR OTHER LEADED PRODUCT AS THE LAST THREE
PREVIOUS CARGOES. THE LAST THREE CARGOES CARRIED IN THE TANK (S) RECEIVING THE
CARCO WERE:

I.

Ships Tanks
2P,25
3P,3S
4P,4S

No.

Last Caroo

2ND Last Carqo

3RD Last Carqo

MOTOR GASOLINE
MOTOR GASOLINE
RECOATED

FISH FAI'S OIL

RECOATED

RECOATED
RECOATED

RECOATED

RECOATED

IN EACH TANK THE PERCENTAGE OF THE IMMEDIATE PREVIOUS CARGO WAS NOT LESS THAT
60 PERCENT BY VOLUME OF THE TANK
2.

FOR INFORMATION ONLY AND WITHOUT RESPONSIBILITY ON SELLERS, PARTICULARS OF

THE LAST THREE CARGOES CARRIED.

3.

THE TANK(S), TANK HEATING COILS, LINES, PUMPS OR FITTINGS USED FOR LOADING,
CARRYING OR DISCHARGING THE OIL DO NOT CONTAINED COPPER OR COPPER ALLOY,

MASTER'S / OWNERS GERTIFICATE

TO WHOM IT MAY CONCERIV

Port Of Loading

:
:

PULAU LAUT. INDONESIA

Port Of Discharging

SINGAPORE

Vessel i Voyage No.

MT. SICHEM MONTREAL

Quantity / Commodity

...

"lyrl"-{"

Shipper / Charterer

PT. GOLDEN HOPE

Ship's Tank/s No.

2P,2S,3P,35,4P,45

" "

I5

35

p-mP-L-_E_F__4Lllll_r4].ry Ac I D

NUSANTARA

sI

LArE N
I

NESTE SINGAPORE PTE LTD

We Certifu That,
1

Ship's conforms to the FOSFA lnternational Qualifications for All Ship's Engaged in the Ocean Carriage And
Tran-shipment of Oils and fats and Oleo-chemicals use in force at the date of Bill of Lading.

2.

Ship's is managed to the standard required by the FOSFA international Operational Procedures for Ocean
and fats and Oleo-chemicals use in force at the date of Bill of Lading.

3.

Ship's tank/s was / were stainless steel

4.

The immediate previous cargoes in the tanUs, lines and pumps system receiving the goods of the contract
description *was not/wasa product appearing on The FOSFA lnternational LBI ol Banned / Acceptable Previous
Cargoes in force at the date o f Bill of Lading and the tanus had not contained any leaded petroleum or other

2P,25
3P,35
4P,45

No.

First Last Carqo

Second Last Caroo

MOTOR GASOLINE
MOTOR GASOLINE
RECOATED

FISH FATS OIL

RECOATED

RECOATED
RECOATED

RECOATED

Third Last Carqo

RECOATED

For information only and without responsibility on sellers, particulars of the last three cargoes canied.

5.

We stating that any tank/s, tank heating coils, lines, pumps or fittings used for loading or
carrying the oil do not contain copper or copper alloy

Date

lssued and signed by,

ey,%
E?l] '[o'i
N{;X;k"uz

(r-

ocr,

:\ii:!tfFj

of

Oils

coating.

leaded product as the last three previous cargoes carried which were as follows:
Tankls

:
") Delete where not applicable

]l$n tIrnECrII tI CrllllttcE cllilurEss

Ship

MT

Owner

IE^M r4lt1f-Es 9l:l:/.-c"r"A99..!]-D-...

Operator

TEAIV] TANKERS CITY CLASS LTD

for

lnspecled
Cleanliness at porl

SICHEI\i1 MONTREAL

Ship's Tank

JUNE

11

3P

Benh JETry
at (Time)

2016

tt 5It75 IltI

PULAU LAUT INDONESIA

On (Dated)

il! E]mttfir

... .....'1.11.5. ...........

PT. GHN

hours.

We hav sighled a staiemenl in lhe fo.m oI FOSFA Combined Masteis Cenmcle sisned by ine 'Captain/Fi6l Office. or an eqlivarent starement signed
'ship's owneG/auhorized agenl certilying rhal lhe abovonamed ship complies with the FOSFA Ouamcatuns and Operarionai Procedures.
P,io. to anspecrion we wre informed W shio's 'egEio/Firsl Oficer thai tte rank was
'a) sr.'irc{r 'b) Mard std coaled wi0l ( descdprbn of coatrng EPoxY )

by

the

Mird 6lt

We recived a copy or a sialmeat signed by ships captain, owErs or authorized aqnt cerli9ing U|ar:
a. The immediatc previous @rso in dhe tanks @s not a substance appearing on $e FoSFA List of Ban.ed hmediate PrBvious Calgo65 in fo@ a he dare of
lhe Bills of Lading and lhe lank complies with lhe restictids beyond the lmmediste Previous C5rgoes as *t out in the FOSFA List of Banned lmmediate
Previous Cargoes. The thee previous cargoss cnied are stated to have ben:

Shi6T.nhNo

3P

b.

Second

MOTOR GASOLINE

RECOATED

Thi.d LNt Creo

RECOATED

The immediale previous 6190 in lhe lant was a substance on he FosFA Lisr of Accplrable Previous csrg@s in force ar tlle date ol the Bitus
Lading and lhe t3nt @hplies wilh lhe Reslriclions byond the lmmedi.te Fevious Cargo as set out in the FOSFA List of A.@ptabte Previous Cargoes.
The inree prevjous cargoes cmied are staied tohavebenl

of

Ships

c.

Lnl CrEo

FiBt Last Ciruo

lnnk

FiBr Llsl Caeo

No

S.codd

'l hird L2sl Careo

Lat Clreo

Applieble to mild slel lanks only - Tho thre previous @rgoes were oils and tals for edibt and oto(,|emict

Siim Tp& No

FiBr l-r!r CrEo

Srond

w.

siafited ships log whicn @n6nEd dE aboE inro.maufi as to

less ltun 60 percenl by volume of lhe tank.

fe

last

l-srC.Eo

u*

andor motas*s and were stared to have

I hird Lsl (rrreo

th@.aa@s nd the pqc.nrage ofrhe

immediare prcvious caryo in the tanks, wnich

M5

We were hiormed by shlp's CHIEF OFFICER/MASTER $al lhe tank had besn cleaned after lhe last caruo by ushg ln6 following cleaning proedure:
BUTTERWORTHTNG WTH W nM SEA WATER (60"C) FOR r HR.
BUTTERWORTHING WITH AMBIENT FRESH WAIER FOR 20 MINUIES.
DRAINING OF TAI'IK. LINES AND PUMPS.
MOPPINGAND DRYING,

d@

Tank ws examined intsmally for cl@nliness as fa. as coold bo sei was iound Io be
and dry and tie trom hannfi,l mrond ard, in @r opinion, in Ors
rspecl based on our visual inspecrion and ar the ume of our inspection. was in ft srare to receive E cargo or TRACEABTE PALM FATry ActD DISTTLLATE IN BULK

From our inspeclion we iound Ihe lank consttuction was

(a).

' SaaicL..{.c
' lvlild sleel coated and as far as could be seen the coatng appeard io be in sound condilion wih minimal
' Mild 6l.0l and a6 f.r as esld b. a8n .ppam ' le b 'n reled ceE{li{e6+ilhegl.l .r.

ShiP! ca$o

mild siel exposlre, withou! loos scale or dosd

pumPs and fircd pipelines wre hspded as rar as possibl in situ and based on vis@r inspecton tound lo be clean and drywith

We wilnessed an application

of liv6 siam,'hol waterftermal heaiing lluid

bars ,or s priod of.........-20-.. TINUIES ad ueE iound light-

lo iank coils and/or

hear exciengrs ro nor ress

than

.:...,.......... kpa .....7-........

As far as could b *n fro,n ou. visual inspeciirn, tie halch covels and joi. ino appeacd ro b in sound condilibn. itE seats ard psckjno did not appear to
contain coppr or copper alloy and there was no coppr or coppr alloy in lhe piplines, pumping syslsm or rank inrem.r mings wfierc they v,erc tn contact wiul

lnspeclion compleled

at

.1_220_...

hours on

JUNE

11

2016

(Date)

(rOSf A Membe, Superintendent)

4.H%

c:'i a111
'l?
ar) Nll.:*7

].SH CTIIIEETII

lI

CIT?II|IC1 EEilUTItS

Ship

MT, SICHEM MONTREAL

Ownr

TEAM TANKERS CITY CLASS LTD

lII

sIIIIIII|IY II $II7$ IilI

Ship's Tank

operator

.IF4l4.-I.fl$F-BP.glIY

lnspected fo.
Cleanliness at port

PULAU LAUT, INDONESIA

On

(Daled)

3S

-C_!4S-S__LJ-D-............................

Berth JETry

PT. GHN

at (Time) .........1.115............hours.

JUNE 1'1,2016

We hav sigllled a stalmenl in Ihe fonn ol FOSFA Combind Masbrs Certilicte signed by the 'Captain/First Offcer or an equivalent stalemenr signed
'ship's owners/auhonzed agent crlitins lh.l lhe abov named shap complies wilh the FOSFA Oualifications and Operationar Prc.dures.

Prid lo inspeciion we wre i.formed by ship s ,C.plaicriEt Ofi@r thai the tank was
'a) srainls{red 'b) Mird steel coaied with ( descriplion of @arng EPoxY )

by

lhe

uru-ctt

We rceived a @py of a slalemenr signed by shlp's cpi6in. oMe6 o. authodzed sgeflr ertifying tEt
a. The immediaie pr.viG @,go in the tanks was not a sun*ane apped,ing on the FOSFA Usl of Banned lmmdiate P@ious C6rg@s in lb@ ar tE daL or
the Bilus of Ladino and lhe tankcomplies wiin tne.estrictjons byond lhe lmmediate Prcvious Cargoes as st od in the FOSFA Listof Banned tmmedirte
ProMous Cargos. The lhree previous cargoes canied are stated to have been:

5!d !!!&

35
b-

Seond

I\4OTOR GASOLINE

RECOATED

Lsr Cuqo

Third

Lsr C.Eo

RECOATED

The immediate pEvious e&o in the lank was a substanc on rhe FOSFA List ol Pacplable Previous CaQoes in b@ at ihe date of the Bitl/s
of Ladins and lhe lan* @mpries wih he Restictions bqpnd Ule lmnEdiale pEvious CaAo as set our in he FOSFA Ust or a@ptaue Previous Cargoes.
The hree previous cargos caded are slaled loh.vebeen:

Tr

Ships

c.

Fid L,n C,rqo

kNo

Firsr l,{sr Careo

Applic3ble to mild sleel lanks

Sni6 Trtrt No

Second

ont - The lhree previous carg@s rere oils and lals lor

Firn l,!st CaEo

Third L$t C,r!o

L{st Carso

Sond l,,sr

We sighlod ship's log {ttich @olimed the above infomadon a5 to lhe lasl lh@
less than 60 perceni by voltlme of the lank.

edible and oleorirnicl

'I

Crrlo

Eoes and the peE.ntage oflh

u*

andor molasses and wre siatd Io have

l'ird l,r( a{rro

immediare pcvious @Go ln

fte tants, wnich

w?s

We ure infomed by ship's CHIEF OFfICER/MASTER lhai th tank had ben clened efrI lhe lasl cargo by using lhe following creaning procedure:
BUTTERWORTHING WITH WARM SEAWATER (6O"C) FOR 1 HR,
BUTTERWORTHING V{ITH AMBIENT FRESH WATER FOR 20 MINUIES.
DRAINING OFTANK, LINESAND PUMPS.

.
.
.

MOPPINGANO DRYING,

to b6 d@n and dry and fte from hannli,l materj.t aod, in our opinion, h ihis
lvas infrr siate to recsivea@rgooTRACEABIE PAIM FATry ActD DISI|LLATE tN BULK

Tank was examinod inlomally for cl6anliness as far as @uld bs sen Eas found

respeci based on our visual inspoclion and

al lhe time ofourinspeciion,

F.om our inspeclion w found t)e lank @nstruclion was

(a).

'

'
'

SraiaL...t

Mild steel coated and 6s far as euld be seen the coaiing appeared to be in sound @ndition wiri minimal miE steer exposure, without loose scale or closed bliste.
Miki 6lt!d .slari 6slel b En .pp.ered le bo in 6ss-d enCiten r$tl6ut t@8. -c.,6.

ShiP's cargo pomPs and ntd pipelines were inspected as far as possible insitu snd based on

we

viMl

inspeclion roond to be clan and dry$itir

witnessed an aPPlicaijotr ol live steam/hol wste/themal heatng ntrid to tank coils and/or heat exchanoeB to nol less

bars for a penod of .-....,.-20-,. MllrlUTES and

rere

inan

,ound Iighr.

-......_..._._

tpa .....7........

As far as could be seen frcm our vBual inspelion. tie haich covers and ioinlinq appeared to be in sound condition, ttre sals and packnrq did nol appear io
contain copper or coppr alloy and therc uas no copper or copper alby in fie pipelanes, pumping syslem or tank intemal rtlin$ where lhey wEre in contacl wiih

lnspection completed at

.1-220-._..

hours on

JUNE

11

2016

(FOSFA Member Sup.DnIndeno

(Date)

ffi-tlo-,gPq'*"'

s*..$,1&*sl
A\$I

Il$rr cImEilIt ff ctrrurrcE

Ship

MT, SICHEM IVIONTREAL

Owngr

TEAM TANKERS

CIry CLASS LTD

Operator

TEAM TANKERS

CIry CLASS LTD

lnspected for
Cleanliness at port

ilJ.-r+y_.$lll.lllP9l-,,rFs-.r
On

(Dated)

ilrI

clltntrtstilt EUIt]tlII tts]rs

Ship's Tank

................................. ............

Borth .:l-EI.1lr'l

2P

--G.

lll!........

.......

at (Time) .........1.11.5.............h0urs.

JUNE 11,2016

We have sighted a statemenl in tne form of FOSFA Combined [iasteis Cenmcale signed by the 'Caplain/Firsl Oflicer or an equivalenr slatemst sigfled
'ship's ownersL/aulhodzed agenl cenirying thal the above named ship complies wilh the FOSFA OualincaUons and Opetional Procedures.
Prior lo inspecton w werc aniormed by ship's 'e3plei*firsr Officer inar he rank was
'b) Mild srel coared lvidt ( desc.rption of coalinq EPOXY

'a)

Slaial$.le.l

by

lhe

,c) r,litd+lt

We received 6 @py of a stalemenl signed by ship's eptain, owners or auihorized agent cedirying thal:
The imtdiate pEvious @rgo in the iEnks ms mt a substan@ appad.g on tte FOSFA tisl of Banncd lmmdiaG Pcvious CaQoes in iorce al the date of
lhe Bilus of Lading and the t6nk complies with lhe resliclions beyond fie lmmediale Previous Cargoes as sei oLn in the FOSFA Ust of Banned hmed'aie
Prcvious CaQoes. The hree previous crgos canied are slated io have been:

a.

rirsi

SIiIIIIId-U!

2P
b.

Second

MOTOR GASOLINE

LBI Capo

Third Llst Crqo

FISH FATS OIL

RECOATED

Ihe immediate prcvious 6190 in rie rankms a subslan@ oi the FosFA List ol AE4ptable Previous cdgoes in force ar ttE date of nE Eilus
of Lading and the tank complies wilh the Reshctions beyond the lmmediale previous Caroo as set oui in ltl FOSFA Lisl of Acceptable Prcvious CaQoes.
Therhree p.evlous cargoes canied are s6ied tohavebeen:

S[ips l,nk Nu

Lnst Cnreo

l irsr l,nn

applicable lo mild steel tanks

!i6r

!-ti!!l aa!-l!l

(l,r!a

only

Seco d

TIn{ L,sl (rr.qo

Lrn C,reo

The three previous carg@s were oils and lars tor edible and olecchemic.l use and/or molasses and

l-{sl C,rqo

Sr.ond

rere staied io have

f!!d!4!&!ce

Lin C,r!o

we sighled ship s log which confirm.d the abovo infomaiion as to the lasr th@ ergoes and rhe percentaoe of the immediale previous @r!o in rho tanks, lvnich
less iian 60 percenl W volme of the t nk.

ras

We were infomed by ship's CHIEF OFFICER/MASTER ihat lhe tank nad been cle8ned afler the last cargo by using lhe following cleaning procedure:
AUTTERWORTHING WTH WARM SEA WATER (60rc) FOR 1 HR,
BUTTERWORTHING WITH AMBIENT FRESH \IIATER FOR 20 MINUTES,
ORAININGOF TANK. IINES ANO PUMPS,
MOPPINGAND ORYING-

Tsnk was examined intemally for cleenlinsE .s far .s could b s6n w93 tound lo be clan 6nd dry and tr6 ftom h.mtul mat6,ial and, in ow opini@, in this
respect based on ou. visual inspeclion and at lhe lim or our inspeclion. was in fit state lo receive E cargo oTTMCEABLE PALM FATTY ACID DISTILLATE lN BULK

Fmm our inspeclion we iound lhe tank construction was

(a).

'
'
'

S{.ielese{rsl
lvlild sleel coaled and as far as could be
Milc Ere.l.nd.6fare Jd r @.

Ship'r ergo

sen

the @ating appeared to b in sound condition with minimal mjld steel exposure, wilhoul loose scale or closed blister

pumps and fxed pipelines vvere inspeded as far as possibl in-situ and based on visual inspction found lo be clean and drywih

We wirnessed an appliallon

of live sleam/hol Mie./hemal healino

bars tor a priod of ........-20... MINUTES and wre iound lighi.

ruid lo tank coils an.lor

heal exchaflgers to not less

lhan

l<pa

As farss could be sen fiom our visual inspeciiln. ltE halch cove6 and iointinq appeared lo be in solnd conditon.lhe sals and packng did nol appear !o
contain @pper or @pper alloy and there Bas no copper or coppr alloy in tt'e pipelines, pumping saslm or liBnk inlmsl fllings Bnere they were in @iact

*itl

lnspection completed at

1220

hours on

JUNE

11

2016

(Date)

GOSrA Membcr Suprintnd.no

ffi.ffi
aa
')

Delete

triich l9b8pplicable

IIEII CI|IIECIII

aI

Ctltulltl,

Ship

MT, SICHEIVI MONTREAL

Owner

.IEA!I4

Operatol

TEAM TANKERS

for

lnspected
Cleanliness at port

CUilUIISs

tll itIIl]UIl
Shlp's Tank

IIII

2S

IAI!5F89 _c_lI _c_tA-sSLIq

CIry CLASS LTD

Be.th

PULAU LAUT INDONESIA

a] EI|TS

On (Dated)

JUNE

11

at (Time)

2016

JETTY PT. GHN

.........'1.11-5-............

hours.

w have sighied a stateftnt in the fmol FOSFA Combined Masteis Cenificaie sagned by nE 'Capiain/Farsi Officer or an equivalent statement signd
'ship's ovners/a!fionzed agenl cedirying lhat the aboveflamed ship complies wilh lhe FOSFA Ouahlietions and Opralional Procedures.
Pior to i.sDeclion w rere iniorned by ship's 'e.daicFirsl Ofier that Ihe lank Ms
'a) s&ii$6s{rd
't ) Mird sreer coared wih ( descriprion of coarnq EPoxY )
We

by

lhe

I ui4&d

@ived

a copy of a statemenl signed by shiCs caplain, omrers or authorned agnt cerlifying lial:
The immediale previous cargo in lhe lanks ms not a subslEre appea.ing on ttie FOSFA List of Banned lmm6diaie Pvioqs Cargoes in forc. at the dala of
lhe Bill/s of Lading and lhe tank complies with the reshctions beyood lhe lmmediate Previous Cargoss as set out in ihe FOSFA Llst of Banned lmmediale
Prcvious Crrgoes. The lhe previous csrgoes cnied are slated to have been:

Shios

Lnk

No

25
b.

l'irst Lnst Carro

S{otrd Lrst Carco

Third Lasl Cnro

MOTOR GASOLINE

FISH FATS OIL

RECOATED

tant{ias a sh3lance on |he FOSFA Ust of Acceplaue Prvious Callos in iorce at fie daie or ltE Eilus
complies wilh lt|e Reslricuons beyond the lmmediale paavious Callo as s! qn in itr6 FOSFA tist of f@ptable Previous C.rgos.
are slaled to have been :

The immdiale previrus caryo in lhe

of

Lading and

tlE iank

The lhree previous carooes cnied

FiEl Lasl Clreo

ShipsT.nkNo

c.

Appltcabl to mlld sleel ianks only

Second

Third L$t Crrqo

Crao

The hree prevlous cargos wErc oils and lals

Iin!]a{&I8e

Lhill-I!4t&

Lssl

iof

edible

afi, olecchdnrcal

'l hird L.sl

S!!9!q-Lsl!rl3e

W sighled ship's loq etrici conllrmed tne above infomalion ss io the lasi thEe crgoes
lass than 60 percent by volume of lne tank.

use and/or molasss and wEfe nated to have

6.d the

C..so

percsniaqe of the immediate prevjous c,go

an

iho tanks, whici was

W were infomed by ship's CHIEF OfFICER/MASTER lnat he tank had ben cleaned afrer Ihe lasl crgo by using tne following claning procedure:

.
.

8UI-TERWORTHING wlTH WARM SEA WATER (6OPC) FOR I HR.

BUTTERWORTHING WITH AMBIENT FRESH WATER FOR 20 MINUTES,
DRAINTNG OF TANK, TINES AND PUMPS,
MOPPINGAND DRYING,

Tant w.s emined i n mdv for cl*nlimss as fer as could b sen Ms found lo b clon and dry nd Ae nom hmtu maro,ial end, in @. opidon, in rhis
rospect based on our visual inspction and at the lim ofourinspecllon, w.s inftslaleto re.eiv6acsrgooTRACEABLE PAIM FATTY ACIO OISTILIATE lN BULK

From our inspcllon a found

(5).

'
'
'

lie

tank conslruclion was :

S{.lrlatC
Mild steel coaled and as fsr as could be sen Ule coaling appearcd to be in sound condition wiul minimal mild steel elaosure, wilhorn bose scale or closed blisler
MilC E!..1 anc .E f.r eB eeulc ba 6a.n app..r6C b be in 6esnd endilien ailhesl le$ eeala,

ShiCs @rgo pumps and fred pipelines wre inspeded 6s far

We witnessed an applicalion

possibb iEsitu 6nd basd on viealinspdion found lo be d@n and drywih

of "ljve st6amfioi waier^hrmal heating flujd

bars for a penod of ._......20... llillNUTES and were found tighl.

to lank coils and/or

heal exchangers lo nol less

ltun

..'...............kpa.....]l'........

As far as couH bo seen fom ou visuai inspclion.lhe hatch coveB 6nd ioirijrq apreared lo be in sound @ndi0on, $e sals and p4ldng did noi appear Io
contain clpper or copper alloy and liEre was no copper or copper alloy in lne piplines, pumping syslem or iank inlemal ftlings wirc they !'/ere in coilacl with

lnspection completed at
rssucasy:

PTf

.1-220_...

hours

on

.,ll/.Lt-E-..1.1r.?9.19.......................

(Date)

(FoSrA Merb.r Sup.nnicndcnr)

t+-Jq.:l

L'-" "-B'lX

')

oelete whidr is

inlpfSrbb

IlSn trlIECtrr !I

tlrlrurtI, Etlilltfttt llt Et]il]lfir tf iltPt ilIr

Ship's Tank

Ship

MT, SICHEM MONTREAL

Owner

TEAM TANKERS CITY CLASS LTO

Opelator

TEAM TANKERS CITY CLASS

for

lnspected
Cleanliness at port

LID

Berth

PULAU LAUT INDONESIA

On

(Dated)

JUNE

at (Time) .........1.115............

1, 2016

JETTY PT. GHN

hours.

We have sighted a stalement in tie form of FOSFA Combined Masteis ceriifr@re signed by the 'CapEin/Fi6t O,ffcer or an oquivalenl statemenl signed
'ship's owne.s/aurhorized ageni @dirying th6t the above named ship compries with the FOSFA Oualifcalions and Operaiional Procedures.
Pfor to inspclton w wEr6 iniomed by shap's eprai/FiBt Otrcer rhat the rank was
srid*tel 'b) Mird sleer coaled wlh ( desqiption of @fng EPoxY )

'a)

by

lhe

'c) Mird-6{6c

We received a copy of a shtemenl signed by ship's captain, ouners or aulhoized agent cedrying thal:
a. Th6 immediate pEvious cIgo in the tanxs wEs not a substan@ appearing on ifie FOSFA Lisl of Banned lmmediate Prcvious Caoes in io@ 6t lhe datt of
the Bilus of Lading aM tie ranl mmplies wlh lhe re$ndions beyond fie lmm.diate Previous Cargoes as st oui in lhe FOSFA List of Banned lmmediate
Previous Cargoes The three prcvious carsoes canied are stated io have ben:

!Iip&!r!-!g

Firn

4P
b.

RECOATED

Shios

Third

Careo

Lsr C,ro

RECOATED

RECOATED

The immediale previous caroo in he tanl was a subslance on rhe FOSFA tist of A@pi,able Pcvious CaQoes in io@ al he daie ot the Balus
Ladino and rhe lank complies wilh lhe RostriclionE beyond lhe lmmediale previous CsAo as sel oul in lho FOSFALi5I of Acceplable Previous Cargos.
The three prsvious cargos canied are $ded to hfle ben :

of

firsr

!:Ep! !!!!L-rys

c.

Seod L.ir

l-nsl Carso

l,nsl

Appltcble to mild steel ranks onv

C.rto
- rhe

S.cotrd Lrst

Third Lnsr Caeo

tnree previols cargoes were ods and lals

airsl Lnst C.rtu

Tnnk No

Crrlo

S.cotrd

We siolid ship's log shin cdrfimed nF abore iniomarion as to th

less lian 60 prcent by volume oI me |.nk.

lor

edlDle and ole+dremlcal use andor

'l hird L,sl

L.!r C,.co

l6t lhB

carg@6

a.d dr.

.
.
.
-

k w's emined intamalt fo. cl,ear imss as rd as @H

respet bas6d on our visual inspeclion 6nd at the time

and were stated to have

Cr{o

pe@nlEge of ttl. immedlaG previous @r!o jn the ianks, which

We vvrs iniormed by ship's CHIEF OFFICER/MASTER lhat lhe tank had besn cleaned aner Ue lEd cargo by using
AUTTERWORTHING WTH WARM SEA WATER (60'C) FOR 1 HR.
BUTTERWORTHING WITH AMBIENT FRESH V{ATER FOR 20 MINUTES,
DRAINING OF TANK. LINES AND PUMPS,
MOPPING At'lD ORYING.

molas*s

fie

Ms

following cleaning procdure:

sH

b
wss tound to b doan and dry rld lie tio.n harmtul nEteriar and, in our opinion, in this
o( our inspeclion, was in fl slsle lo roceive a crqo o TRACEABLE PALM FATTY ACIO OISTIILATE lN BULK

Frcm our inspection we found lne iank coflslruclion was :

(aI

'Sra'abqrste.l

'
'

Ilild steel coared and as rar as could be sen the coating appeared to be

itild

6l.1

a.c.s

faraE cesld

Snip's caQo pumps and fixed pipelines werc inspeted as tar as possible

We witnessed sn application

in sound

condiiion wiih minimal m d steel exposure, wilhoul loose scale or closed blister

@.

ol live sream/holwaterlhermal healing nuid

rere found iight.

in

silu snd based on

lo iank @ils ancuor

visual insgeclion found lo be clean and drywith

heat exchsngeG to not less

bars tor a pe.iod of ........20,... MINUTES and

lnan

kpa

As far a6 could b seen from ourvisualinspeclion.lhe halch cove6 and joinlino appeared io be in sound condition. th6 Eeals and packing did nol appearlo
codain copper oa copper slloy and Iherc wss oo copper or copper alloy in rhe piplires. pu,npang sysi4n or rank inlemal ftlings wnere ihey wre in coniacl witi

ihe cargo.

lnspeclion compleled

al

1220

hours

on

JU_N-E.I]|,.2016.........._,.-......... (Date)

(FOSFA Mcmbr supenntendrno

6"[ffi
ia
')

DdeG wnicn is inlDob3ble

nsil t[lIrEtlIE

aI

tllllttltE cllilt!ffs$ ttt ttlIt]ltll tI EItp$ ilil

Ship

MT. SICHEM MONTREAL

Owner

TEAM TANKERS CITY CLASS LTO

Operator

TEAM TANKERS CITY CLASS LTD

for

lnspected
Cleanliness at port

Ship's Tank

Be h

PULAU LAUT INDONFSIA

On (Dated)

JUNE

11

at

2016

(Time)

4S

.J.ETTY

P.T..GLiN..

1115

...

hours.

or FOSFA Combined Maste/s Crtr'fcte signed by the 'CaptsirvFirst Oflicer or an equivaleni siatemsnt signed by the
'ship's o$,flarvadhonzed sgenl cediting that the 6bove named ship complies wnh he FOSFA Ourlili@tions and Operational Procdures.

We have sighted a st6iemern in the rom

Pnor to insoection w wrc iniormd W shio s 'eedaiE/First Ofncer that the tank was
'b) Mald slel coated wih ( descdplioo or coaring EPO)ry

'a)

Staiibs.red

,
rc) Ulld+ret

We receivd a copy of 5 stiatemenl soned by ships caplain, owners or authod2ed ageitt @diting mal]
a Thc imm.dial. prcvious ca.go in th. ianks ms .ol 3 suBtance appeadng oa lhe FOSFA List of Banned hmedi.t6 Prcvjous Ca.goes in io@ at the date oa
lhe Bilus of tading and lhe t nk complies wiltr [l rcslnclions beyoid Ule lmmedaare Previous Cargos as set oul in iie FOSFAL|SI ofBanned lmmediate
Previous Caryoes. The lhree previous crgos caried are slaled lo have been:

ShiN IhkN.

45
b.

l.irsl Lrsl Cnreo

S?cond

L,st Cnrlo

RECOATED

RECOATED

Third Lisl C..co

RECOATED

was a substance on he FOSFA llsl of pceptable Previous Caeoes in fo@ al lhe dale of ihe Bilus
ol Ladinq and ihe lank complies wnh lhe Restriciions beyond llle lmmediale previous Cargo as set oul in the FOSFA List of A@plable Pr*ious Carucs.
The lrxee p.vious ca.goes canied are srarsd ro h4e been :

The immediale previous

Snios

c.

I{nk

\o

fuplieble lo

ergo

fiBl

in Ihe

tad

mild sleel lanks only

The threo previous caqoes were oils 6nd laB

FiBI t,asI (}Fo

Shios T!trk No

'llrird

S..ond Lasr C,r!o

Lnsl Cnre6

lor

edible and oleeciemacal use and/or molasses and were stated to have

S(ond L$l (l!eo

We sign@d ship's log wnich cofiltumd ore aboE inbmali@ as io dte bsr thEe
less lhan 60 prcnl by volume or the tank.

l-r (irso

@Aes and 0E

Ttid
pe.c.nlagE

orft.

l,a3r C,reo

ilmmediate prEvious

@l!o

in

the tants, wtrich

Es

We wre infomed byshlp'sCH|EF OFFICER/MASTER fiat lhe tank had ben cleaned after the lalt calgo by usinO in6 rollowing cleaning prccedure:
EUTTERWORTHING WTH WARM SEA WATER (6OPC) FOR I HR.
BUTTERWORTHING WITH AMBIENT FRESH WATER FOR 20 MINUTES.
DRAINING OFTANK, LINESAND PUMPS,
MOPPINGAND DRYING,

,
-

Tark was examinod inl6mally for cleanliness as far as @uld bo s6n was found ro be d@n end dry and freo fDm hanrtul nEIrisl and, in ou. opinion. in this
.specl basd on our visual inspe.Uon and al lhe llme or ou. inspeclion, was in fl state lo receive a rgo o TRACEABLE PALM FATTY ACIO DISTILLATE lN BULK

From our inspeciion we found rhe iank construction was

(a).

Ship

' s&rr.rssLc
' Mild sleel coated and 6s far as could be *en
' Mild el3l eaid erar a @.

s crgo pmps

ihe coaling appeared to be in sound condilioa with minimal mild steol exposuc, withoot

l@*

s@le or closed blisrer

and tued pipelines rere inspecled as far as possiue in-!{u and based on visu8l inspdion found to be clean and dry witn

We wihssed 3n applicalion

ot live steam/hotwator/rhrmal
bars fo. a pedod of.........-20... MINUTES and wm iouod lighl.

healing nuid to tank coils and/or hal exchangsrE to not less

lhan

lQa

As faras could b seen trom our vlsual inspeclion, the hatch @veB and joinrins appared to be in sound coodirion. ine seals and pading did.)oi appear lo
contain copper or coppor alloy snd lhere was no copper or coppr alloy in tho piplines. pumpinq sysiem or tank intemal rtllnss where lhey were ln contacl wiih

lnspection completed

at

.1220..... hours

on

jl!:l.Ll.F.].l 2016

(FOSFA

(Date)

M.hbe! Supennlend.nt)

6qif.ffi
p*'Isu,
')

Delete

CERTIFICATE OF CLEANLINESS, TIGHTNESS AND FITNESS OF SHIP'S

TANKS AND CONNECTING PIPELINESS/HOSES
Date

MONTREAL

Vessel / Voyage No.

MT. SICHEM

Port Of Loading

PULAU LAUT, INDONESIA

Destination

SINGAPORE

JUNE

11

2016

35

the undersigned, certify that the following cargo tank(s):

2,3,4

Port

Center
2,3,4

Starboard

To the best of our knowledge have tight bulkheads, pipelines, hoses and valves are in clean &
fit condition to receive the nominated cargo of: TRACEABLE PALM FATTY ACID DISTILLATE lN BULK
Evidencing that tanks, heating coils and appliances used for loading and discharging cargo do
not contain copper or copper alloys.

Tank Coating

EPOXY

Heating Coil

STAINLESS STEEL

Chief Officer's Name

Signature and Ship's Stamp,

6"*T:'Da
&tiih.'ffF
Master / Chief

.r"o*9