AUTHORISED BY: SHIPNET FORM ID:

PHA125 ENV03
REVIEWED BY:
REVISION NUMBER AND DATE:
KKO051
PREPARED / EDITED BY:
3 / 29 Jan. 2018
DTR022

SUBJECT: Disposal of Garbage

Name of Vessel:
Date (dd/mm/yyyy): 12.07.2018
IMO Number:
Flag:
Call Sign:
Berth / Jetty / Other: Dock 2
Port / Location (including Country):Port Allen / Louisiana USA

Type Category Waste fraction Quantity m3 Remarks

A. Plastics a. Plastic 2.4      
B. Food Waste b. Food waste 0.6      
c1. Paper 0.4      
c2. Rags 0.1      
c3. Glass, bottles 0.1      
C. Domestic Waste
c4. Medicinal waste            
c5. Metal            
c6. Other (     )            
Conventional D. Cooking oil d. Cooking oil            
Waste E. Incinerator ashes e. Incinerator ashes            
F. Operational f1. Metal 0.2      
Wastes f 2. Wood            
G. Animal g. Animal carcass(es)            
carcass(es)
Other (EEBD) Other (     ) 0.2      
Other (     ) Other (     )            
Other (     ) Other (     )            
f3. Chemicals            
f4. Paints 0.1      
f5. Fluorescent tubes            
F. Operational f6. Batteries            
Hazardous Wastes f7. Oily filters            
Waste f8. Oily rags 0.3      
f9. Pyrotechnics            
f10. Other (Old Samples) 0.2      
H. Fishing gear h. Fishing gear            
I. E-waste i. E-waste            
Any Comment:      

Total Quantity Discharged: 4.6 m3

Signature of responsible officer Signature of receiver

     

Name & Rank in Block Letters Name / Function (Rank) in Block Letters

Retention time: This document shall be preserved for a period of two years after the last entry is made on the record-book.
Page 1 of 1 Printed: 24-04-2019