Appendix

 

KARMSUND PORT AUTHORITY        KÅRSTØ GASSBEHANDLINGSANLEGG

NOTIFICATION ON DELIVERY OF WASTE FROM SHIPS

 

Information to be notified before entry into the port of: __________________________________

 

1. Ship’s name:________________________  Call sign: ______________________________

 

2. IMO number:_____________________ Flag state: ________________________________

 

3. Estimated time of arrival (date and time): _______________________________________

 

4. Estimated time of departure (date and time): ____________________________________

 

5. Previous port of call: ________________________________________________________

 

6. Next port of call: ____________________________________________________________

 

7. Last port where waste was delivered and date of delivery: _________________________

 

8. Number of crew: _________________ passengers: _______________________________

 

9. Type and amount of waste and cargo residues to be delivered and/or remain onboard:

 

Type	Waste to be delivered (m³)	Maximum dedicated starage capacity (m³)	Amount of waste retained on board (m³)	Port at which remaining waste will be delivered	Estimated amount of waste to be generated between notification and next port of call (m³)
1. Waste oils
Sludge:
Bilge water:
Others (Specify)
2. Garbage
Food waste:
Plastic:
Others (Specify)
3. Sewage (Incl. grey water)
4. Cargo associated waste (Specify):
5. Cargo residues (Specify):

      

       I confirm that the above details are accurate and correct and that there is sufficient on board capacity to store

       All waste generated between notification and the next port at which waste will be delivered.

 

 

 

 

____________________             _______________________           ________________________

 

Date                                                     Time                                                          Signature