CG-4602A 11-16 Oil Record Book-Full
CG-4602A 11-16 Oil Record Book-Full
CG-4602A 11-16 Oil Record Book-Full
______________________
OIL RECORD BOOK
FOR SHIPS
CHECK ONE: This book is for Machinery Space Operations (Part I-All Ships)
Gross Tonnage:
THIS BOOK MUST BE MAINTAINED ABOARD THE SHIP FOR AT LEAST THREE YEARS
FOLLOWING THE “TO” DATE LISTED ABOVE.
As per 33 Code of Federal Regulations (CFR) 151.25, this record book is issued by the Secretary of Homeland
Security and is distributed by the United States Coast Guard to ships of American registry. It remains the property of
the United States Government and each owner/operator is responsible to maintain and surrender it in accordance
with the Secretary's regulations. Note that the Oil Record Book is o n e book with two parts; Machinery Space
Operations is under Part I and Cargo/Ballast Operations is under Part II.
Each oil tanker of 150 gross tons and above, every ship of 400 gross tons and above other than oil tankers, and
manned fixed or floating drilling rig or other platform shall maintain an Oil Record Book Part I (Machinery Space
Operations). An oil tanker of 150 gross tons and above or a non oil tanker that carries 200 cubic meters or more
of oil in bulk, shall also maintain an Oil Record Book Part II (Cargo/Ballast Operations).
Oil Record Books printed by the U.S. Government are available to the masters or operators of all U.S. ships
subject to 33 CFR 151.25, from any Coast Guard Sector Office, Marine Inspection Office, or Captain of the Port
Office.
An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB
control number. The Coast Guard estimates that the average burden for each response is 2.5 minutes. You may submit any comments
concerning the accuracy of this burden estimate or any suggestions for reducing the burden to: Commandant (CG-CVC-1), U.S. Coast Guard,
Stop 7501, 2703 Martin Luther King Jr. Ave, SE, Washington, DC 20593-7501 or Office of Management and Budget, Paperwork Reduction
Project (1625-0009), Washington, DC 20503.
Purpose: The Coast Guard will use this information to inspect ships and enforce compliance with
MARPOL 73/78 and 33 CFR 151 Subpart A.
Routine Uses: The information will be used by and disclosed to authorized Coast Guard personnel to
determine that evidence of compliance is on board, the condition of the ship and its equipment
corresponds substantially with the vessel’s particulars, whether a vessel has discharged any oil or oily
mixtures in violation of MARPOL 73/78 and 33 CFR 151 Subpart A. Any external disclosures of data
within this record will be made in accordance with the DHS/USCG-013, Marine Information for Safety
and Law Enforcement (MISLE) System of Records Notice, 74 Federal Register 30305, (June 25, 2009).
Disclosure: Furnishing this information is mandatory; failure to furnish the requested information may
result in appropriate enforcement measures by the agency conducting the inspection, and possible
restriction on the operation of the vessel.
Table of Contents
Disclaimer:
Selected excerpts of MARPOL 73/78 and 33 CFR 151 regulations pertaining to oil discharge and oil record book standards
are provided in the following pages. These selected excerpts reflect the regulations at the time of this book’s publication.
While the excerpts are provided to give vessel owners and operators readily available reference to certain oil discharge and
Oil Record Book regulations, they do not stand in place of the actual regulations. Vessel owners and operators shall consult
the actual regulations as these references may have been updated after the publication date of this Oil Record Book.
The Code of Federal Regulations (CFR’s) may be viewed on the web at http://www.ecfr.gov.
A copy of MARPOL Consolidated Edition 2011 is available from the International Maritime Organization, 4 Albert
Embankment, London, SE1, SR7, England. (www.imo.org)
Extract of 33 CFR 151.25 - Oil Record Book
(a) Each oil tanker of 150 gross tons and above, every ship of 400 gross tons and above other than an
oil tankers, and manned fixed or floating drilling rig or other platform shall maintain an Oil Record
Book Part I (Machinery Space Operations). An oil tanker of 150 gross tons and above or a non oil
tanker that carries 200 cubic meters or more of oil in bulk, shall also maintain an Oil Record Book
Part II (Cargo/Ballast Operations).
(b) An Oil Record Book printed by the U.S. Government is available to the masters or operators of all
U.S. ships subject to this section, from any Coast Guard Sector Office, Marine Inspection Office, or
Captain of the Port Office.
(c) The ownership of the Oil Record Book of all U.S. ships remains with the U.S. Government.
(d) Entries shall be made in the Oil Record Book on each occasion, on a tank to tank basis if
appropriate, whenever any of the following machinery space operations take place on any ship to
which this section applies--
(1) Ballasting or cleaning of fuel oil tanks;
(2) Discharge of ballast containing an oily mixture or cleaning water from fuel oil tanks;
(3) Disposal of oil residue;
(4) Discharge overboard or disposal otherwise of bilge water that has accumulated in machinery
spaces;
(5) Bunkering of fuel or bulk lubricating oil; and
(6) Any failure, and the reasons for, of the oil filtering equipment.
(e) Entries shall be made in the Oil Record Book on each occasion, on a tank to tank basis if
appropriate, whenever any of the following cargo/ballast operations take place on any oil tanker to
which this section applies--
(1) Loading of oil cargo;
(2) Internal transfer of oil cargo during voyage;
(3) Unloading of oil cargo;
(4) Ballasting of cargo tanks and dedicated clean ballast tanks;
(5) Cleaning of cargo tanks including crude oil washing;
(6) Discharge of ballast except from segregated ballast tanks;
(7) Discharge of water from slop tanks;
(8) Closing of all applicable valves or similar devices after slop tank discharge operations;
(9) Closing of valves necessary for isolation of dedicated clean ballast tanks from cargo and
stripping lines after slop tank discharge operations;
(10) Disposal of oil residue; and
(11) Any failure, and the reasons for, of the oil discharge monitoring and control system.
(f) Entries shall be made in the Oil Record Book on each occasion, on a tank-to-tank basis if
appropriate, whenever any of the following operations take place on a fixed or floating drilling rig or
other platform to which this section applies--
(1) Discharge of ballast or cleaning water from fuel oil tanks; and
(2) Discharge overboard of platform machinery space bilge water.
(g) In the event of an emergency, accidental or other exceptional discharge of oil or oily mixture, a
statement shall be made in the Oil Record Book of the circumstances of, and the reasons for, the
discharge.
1|Page
(h) Each operation described in paragraphs (d), (e) and (f) of this section shall be fully recorded
without delay in the Oil Record Book so that all the entries in the book appropriate to that operation
are completed. Each completed operation shall be signed by the person or persons in charge of the
operations concerned and each completed page shall be signed by the master or other person having
charge of the ship.
(i) The Oil Record Book shall be kept in such a place as to be readily available for inspection at all
reasonable times and shall be kept on board the ship.
(j) The master or other person having charge of a ship required to keep an Oil Record Book shall be
responsible for the maintenance of such record.
(k) The Oil Record Book for a U.S. ship shall be maintained on board for not less than three years.
(l) This section does not apply to a barge or a fixed or floating drilling rig or other platform that is not
equipped to discharge overboard any oil or oily mixture.
(m) This section does not apply to a fixed or floating drilling rig or other platform that is operating in
compliance with a valid National Pollutant Discharge Elimination System (NPDES) permit.
1. Subject to the provisions of regulation 41 of this annex and paragraphs 2, 3, and 6 of this
regulation, any discharge into the sea of oil or oily mixtures from ships shall be prohibited. 1
2. Any discharge into the sea of oil or oily mixtures from ships of 400 gross tonnage and above shall
be prohibited except when all the following conditions are satisfied:
.1 the ship is proceeding en route; 2
.2 the oily mixture is processed through an oil filtering equipment meeting the requirements of
regulation 14 of this Annex; 3
.3 the oil content of the effluent without dilution does not exceed 15 parts per million;
.4 the oily mixture does not originate from cargo pump room bilges on oil tankers; and
.5 the oily mixture, in case of oil tankers, is not mixed with oil cargo residues.
3. Any discharge into the sea of oil or oily mixtures from ships of 400 gross tonnage and above shall
be prohibited except when all of the following conditions are satisfied:
.1 the ship is proceeding en route; 2
.2 the oily mixture is processed through an oil filtering equipment meeting the
requirements of regulation 14.7 of this Annex;
.3 the oil content of the effluent without dilution does not exceed 15 parts per million;
.4 the oily mixture does not originate from cargo pump room bilges on oil tankers; and
.5 the oily mixture, in case of oil tankers, is not mixed with oil cargo residues.
4. In respect of the Antarctic area, any discharge into the sea of oil or oily mixtures from any ship
shall be prohibited.
2|Page
5. Nothing in this regulation shall prohibit a ship on a voyage only part of which is in a special area
from discharging outside a special area in accordance with paragraphs 2 of this regulation.
C. Requirements for ships of less than 400 gross tonnage in all areas except the Antarctic area
6. In the case of a ship of less than 400 gross tonnage, oil and all oily mixtures shall either be
retained on board for subsequent discharge to reception facilities or discharged into the sea in
accordance with the following provisions:
.1 the ship is proceeding en route; 2
.2 the ship has in operation equipment of a design approved by the Administration that ensures
that the oil content of the effluent without dilution does not exceed 15 parts per million;
.3 the oily mixture does not originate from cargo pump room bilges on oil tankers; and
.4 the oily mixture, in case of oil tankers, is not mixed with oil cargo residues.
D. General requirements
7. Whenever visible traces of oil are observed on or below the surface of the water in the immediate
vicinity of a ship or its wake, Governments of Parties to the present Convention should, to the extent
they are reasonably able to do so, promptly investigate the facts bearing on the issue of whether there
has been a violation of the provisions of this regulation. The investigation should include, in
particular, the wind and sea conditions, the track and speed of the ship, other possible sources of the
visible traces in the vicinity, and any relevant oil discharge records.
8. No discharge into the sea shall contain chemicals or other substances in quantities or
concentrations which are hazardous to the marine environment or chemicals or other substances
introduced for the purpose of circumventing the conditions of discharge specified in this regulation.
9. The oil residues which cannot be discharged into the sea in compliance with this regulation shall
be retained on board for subsequent discharge to reception facilities.
NOTES:
1
Regulation 4 is titled “Exceptions.”
2
En route means that a ship is underway at sea on a course or courses, including deviation from the shortest direct route, which, as far
as practicable for navigation purposes, will cause any discharge to be spread over as great an area of the sea as is reasonable and
practicable (MARPOL Annex I Unified Interpretation 28).
3
Regulation 14 is titled “Oil Filtering Equipment.”
1. Every oil tanker of 150 gross tonnage and above and every ship of 400 gross tonnage and above
other than an oil tanker shall be provided with an Oil Record Book Part I (Machinery Space
Operations). The Oil Record Book, whether as a part of the ship’s official log-book or otherwise,
shall be in the Form specified in appendix III to this Annex.
2. The Oil Record Book Part I shall be completed on each occasion, on a tank-to-tank basis if
appropriate, whenever any of the following machinery space operations takes place in the ship:
.1 ballasting or cleaning of oil fuel tanks;
.2 discharge of dirty ballast or cleaning water from oil fuel tanks;
.3 collection and disposal of oil residues (oil residue (sludge);
.4 discharge overboard or disposal otherwise of bilge water which has accumulated
3|Page
in machinery spaces; and
.5 bunkering of fuel or bulk lubricating oil.
3. In the event of such discharge of oil or oily mixture as is referred to in regulation 4 of this Annex
or in the event of accidental or other exceptional discharge of oil not excepted by that regulation, a
statement shall be made in the Oil Record Book Part I of the circumstances of, and the reasons for,
the discharge.
4. Each operation described in paragraph 2 of this regulation shall be fully recorded without delay in
the Oil Record Book Part I, so that all entries in the book appropriate to that operation are completed.
Each completed operation shall be signed by the officer or officers in charge of the operations
concerned and each completed page shall be signed by the master of ship. The entries in the Oil
Record Book Part I, for ships holding an International Oil Pollution Prevention Certificate, shall be at
least in English, French or Spanish. Where entries in an official national language of the State whose
flag the ship is entitled to fly are also used, this shall prevail in case of a dispute or discrepancy.
5. Any failure of the oil filtering equipment shall be recorded in the Oil Record Book Part I.
6. The Oil Record Book Part I, shall be kept in such a place as to be readily available for inspection
at all reasonable times and, except in the case of unmanned ships under tow, shall be kept on board
the ship. It shall be preserved for a period of three years after the last entry has been made.
7. The competent authority of the Government of a Party to the present Convention may inspect the
Oil Record Book Part I on board any ship to which this Annex applies while the ship is in its port or
offshore terminals and may make a copy of any entry in that book and may require the master of the
ship to certify that the copy is a true copy of such entry. Any copy so made which has been certified
by the master of the ship as a true copy of an entry in the ship's Oil Record Book Part I shall be made
admissible in any judicial proceedings as evidence of the facts stated in the entry. The inspection of
an Oil Record Book Part I and the taking of a certified copy by the competent authority under this
paragraph shall be performed as expeditiously as possible without causing the ship to be unduly
delayed.
1. Subject to the provisions of regulation 4 of this Annex and paragraph 2 of this regulation, any
discharge into the sea of oil or oily mixtures from the cargo area of an oil tanker, shall be prohibited
except when all the following conditions are satisfied: 1
.1 the tanker is not within a special area;
.2 the tanker is more than 50 nautical miles from the nearest land;
.3 the tanker is proceeding en route;2
.4 the instantaneous rate of discharge of oil content does not exceed 30 liters per
nautical mile;
.5 the total quantity of oil discharged into the sea does not exceed for tankers delivered on or
before 31 December 1979, as defined in regulation 1.28.1, 1/15,000 of the total quantity of the
particular cargo of which the residue formed a part, and for tankers delivered after 31 December
1979, as defined in regulation 1.28.2, 1/30,000 of the total quantity of the particular cargo of
which the residue formed a part; and3
.6 the tanker has in operation an oil discharge monitoring and control system and a slop tank
arrangement as required by regulations 29 and 31 of this Annex.4
4|Page
2. The provisions of paragraph 1 of this regulation shall not apply to the discharge of clean or
segregated ballast.
3. Subject to the provisions of paragraph 4 of this regulation, any discharge into the sea of oil or oily
mixture from the cargo area of an oil tanker shall be prohibited while in a special area.5
4. The provisions of paragraph 3 of this regulation shall not apply to the discharge of clean or
segregated ballast.
5. Nothing in this regulation shall prohibit a ship on a voyage only part of which is in a special area
from discharging outside the special area in accordance with paragraph 1 of this regulation.
6. The requirements of regulations 29, 31 and 32 of this Annex shall not apply to oil tankers of less
than 150 gross tonnage, for which the control of discharge of oil under this regulation shall be
effected by the retention of oil on board with subsequent discharge of all contaminated washings to
reception facilities. The total quantity of oil and water used for washing and returned to a storage tank
shall be discharged to reception facilities unless adequate arrangements are made to ensure that any
effluent which is allowed to be discharged into the sea is effectively monitored to ensure that the
provisions of this regulation are complied with.6
D. General requirements
7. Whenever visible traces of oil are observed on or below the surface of the water in the immediate
vicinity of a ship or its wake, the Governments of Parties to the present Convention should, to the
extent they are reasonably able to do so, promptly investigate the facts bearing on the issue of
whether there has been a violation of the provisions of this regulation. The investigation should
include, in particular, the wind and sea conditions, the track and speed of the ship, other possible
sources of the visible traces in the vicinity, and any relevant oil discharge records.
8. No discharge into the sea shall contain chemicals or other substances in quantities or
concentrations which are hazardous to the marine environment or chemicals or other substances
introduced for the purpose of circumventing the conditions of discharge specified in this regulation.
9. The oil residues which cannot be discharged into the sea in compliance with paragraphs 1 and 3 of
this regulation shall be retained on board for subsequent discharge to reception facilities.
NOTES:
1
Regulation 4 is titled “Exceptions.”
2
En route means that a ship is underway at sea on a course or courses, including deviation from the shortest direct route, which, as far
as practicable for navigation purposes, will cause any discharge to be spread over as great an area of the sea as is reasonable and
practicable (MARPOL Annex I Unified Interpretation 28).
3
Regulation 1 is titled “Definitions.”
4
Regulation 29 is titled “Slop tanks.”
Regulation 31 is titled “Oil discharge monitoring and control system.”
5
Refer to regulation 38.6 (Regulation 38 is titled “Reception facilities.”)
6
Regulation 32 is titled “Oil/water interface detector.”
5|Page
MARPOL 73/78 Annex I: Chapter 4, Regulation 36 – Oil Record Book, Part II -
Cargo/ballast operations
1. Every oil tanker of 150 gross tonnage and above shall be provided with an Oil Record Book Part
II (Cargo/Ballast Operations). The Oil Record Book Part II, whether as a part of the ship's official
logbook or otherwise, shall be in the Form specified in appendix III to this Annex.
2. The Oil Record Book Part II shall be completed on each occasion, on a tank-to-tank basis if
appropriate, whenever any of the following cargo/ballast operations take place in the ship:
.1 loading of oil cargo;
.2 internal transfer of oil cargo during voyage;
.3 unloading of oil cargo;
.4 ballasting of cargo tanks and dedicated clean ballast tanks;
.5 cleaning of cargo tanks including crude oil washing;
.6 discharge of ballast except from segregated ballast tanks;
.7 discharge of water from slop tanks;
.8 closing of all applicable valves or similar devices after slop tank discharge
operations;
.9 closing of valves necessary for isolation of dedicated clean ballast tanks from
cargo and stripping lines after slop tank discharge operations; and
.10 disposal of residues.
3. For oil tankers referred to in regulation 34.6 of this Annex, the total quantity of oil and water used
for washing and returned to a storage tank shall be recorded in the Oil Record Book Part II.
4. In the event of such discharge of oil or oily mixture as is referred to in regulation 4 of this Annex
or in the event of accidental or other exceptional discharge of oil not excepted by that regulation, a
statement shall be made in the Oil Record Book Part II of the circumstances of, and the reasons for,
the discharge.
5. Each operation described in paragraph 2 of this regulation shall be fully recorded without delay in
the Oil Record Book Part II so that all entries in the book appropriate to that operation are completed.
Each completed operation shall be signed by the officer or officers in charge of the operations
concerned and each completed page shall be signed by the master of ship. The entries in the Oil
Record Book Part II shall be at least in English, French or Spanish. Where entries in an official
language of the State whose flag the ship is entitled to fly are also used, this shall prevail in case of
dispute or discrepancy.
6. Any failure of the oil discharge monitoring and control system shall be noted in the Oil Record
Book Part II.
7. The Oil Record Book shall be kept in such a place as to be readily available for inspection at all
reasonable times and, except in the case of unmanned ships under tow, shall be kept on board the
ship. It shall be preserved for a period of three years after the last entry has been made.
8. The competent authority of the Government of a Party to the Convention may inspect the Oil
Record Book Part II on board any ship to which this Annex applies while the ship is in its port or
offshore terminals and may make a copy of any entry in that book and may require the master of the
ship to certify that the copy is a true copy of such entry. Any copy so made which has been certified
by the master of the ship as a true copy of an entry in the ship's Oil Record Book Part II shall be made
admissible in any judicial proceedings as evidence of the facts stated in the entry. The inspection of
6|Page
an Oil Record Book Part II and the taking of a certified copy by the competent authority under this
paragraph shall be performed as expeditiously as possible without causing the ship to be unduly
delayed.
9. For oil tankers of less than 150 gross tonnage operating in accordance with regulation 34.6 of this
Annex, an appropriate Oil Record Book should be developed by the Administration.
7|Page
OIL RECORD BOOK
PART I - Machinery Space Operations
(All Ships)
Each oil tanker of 150 gross tons and above, every ship of 400 gross tons and above other than oil tankers, and
manned fixed or floating drilling rig or other platform shall maintain an Oil Record Book Part I (Machinery Space
Operations). (From 33 CFR 151.25 (a))
The following pages of this section show a comprehensive list of items of machinery space operations which are,
when appropriate, to be recorded in the Oil Record Book Part I (Machinery Space Operations) in accordance with
regulation 17 of Annex I to MARPOL 73/78 and implemented in 33 CFR 151.25. The items have been grouped
into operational sections, each of which is denoted by a letter Code.
When making entries in the Oil Record Book Part I, the date, operational code, and item number shall be inserted
in the appropriate columns and the required particulars shall be recorded in chronological order as they have been
executed on board. Each operation shall be fully recorded without delay so that all the entries in the book
appropriate to that operation are completed. Each operation should be dated in the dd-MONTH-yyyy format (e.g.
20- JAN-2011). Each Completed operation shall be entered and signed by the officer/person or
officers/persons in charge of the operations concerned and each completed page shall be signed by the
master of the ship.
Incineration or landing ashore of oily garbage and used filters should be recorded in the Garbage Record Book
only.
Do not leave any full lines empty between successive entries. If a wrong entry has been recorded in the Oil Record
Book (ORB), it should immediately be struck through with a single line in such a way that the wrong entry is still
legible. The wrong entry should be signed and dated, with the new corrected entry following.
Tank nomenclature should be recorded as per the format noted within the International Oil Pollution Prevention
(IOPP) Certificate.
The Oil Record Book Part I contains many references to oil quantity. The limited accuracy of tank measurement
devices, temperature variations and c1ingage will affect the accuracy of these readings. The entries in the Oil
Record Book Part I should be considered accordingly. All quantities should be consistently recorded
throughout the Oil Record Book as cubic meters (m3), gallons (gals), or barrels (bbls).
In the event of accidental or other exceptional discharge of oil, statement shall be made in the Oil Record Book
Part I of the circumstances of, and the reasons for, the discharge.
Any failure of the oil filtering equipment shall be noted in the Oil Record Book Part I.
The entries in the Oil Record Book Part I for ships holding an IOPP Certificate shall be in English.
Recording of quantities retained in bilge water holding tanks listed under section 3.3 of the IOPP Certificate is
voluntary and not required by the Convention. The recording of general maintenance of items pertaining to the
OWS remains voluntary and is not required to be recorded in the ORB.
The Oil Record Book Part I shall be kept in such a place as to be readily available for inspection at all reasonable
times and, except in the case of unmanned ships under tow, shall be kept on board the ship. It shall be preserved
for a period of three years after the last entry has been made.
The competent authority of the Government of a Party to the Convention may inspect the Oil Record Book Part I
on board any ship to which Annex I applies while the ship is in its port or offshore terminals and may make a copy
of any entry in that book and may require the master of the ship to certify that the copy is a true copy of such entry.
Any copy so made which has been certified by the master of the ship as a true copy of an entry in the Oil Record
8|Page
Book Part I shall be made admissible in any juridical proceedings as evidence of the facts stated in the entry. The
inspection of an Oil Record Book Part I and the taking of a certified copy by the competent authority under this
paragraph shall be performed as expeditiously as possible without causing the ship to be unduly delayed.
9|Page
LIST OF ITEMS TO BE RECORDED
PART I - Machinery Space Operations
(B) DISCHARGE OF DIRTY BALLAST OR CLEANING WATER FROM OIL FUEL TANKS
REFERRED TO UNDER SECTION (A)
5 Identity of tank(s).
6 position of ship at start of discharge.
7 Position of ship on completion of discharge.
8 Ship’s speed(s) during discharge.
9 Method of discharge:
.1 through 15 ppm equipment;
.2 to reception facilities.
10 Quantity discharged, in m3, gals., or bbls.
(C) COLLECTION, TRANSFER AND DISPOSAL OF OIL RESIDUES (SLUDGE AND OTHER OIL
RESIDUES)
NOTES:
1
Only those tanks listed in item 3.1 of Forms A and B of the Supplement to the IOPP Certificate used for oil residues
(sludge).
2
The ship’s master should obtain from the operator of the reception facilities, which includes barges and tank trucks, a
receipt or certificate detailing the quantity of tank washings, dirty ballast, residues or oily mixtures transferred, together with
the time and date of the transfer. This receipt or certificate, if attached to the Oil Record Book Part I, may aid the master of
the ship in proving that the ship was not involved in an alleged pollution incident. The receipt or certificate should be kept
together with the Oil Record Book Part I.
10 | P a g e
(D) NON-AUTOMATIC STARTING OF DISCHARGE OVERBOARD, TRANSFER OR DISPOSAL
OTHERWISE OF BILGE WATER WHICH HAS ACCUMULATED IN MACHINERY SPACES
16 Time and position of ship at which the system has been put into automatic mode of
operation for discharge overboard, through 15 ppm equipment.
17 Time when the system has been put into automatic mode of operation for transfer of bilge
water to holding tank (identify tank).
18 Time when the system has been put into manual operation.
22 Time of occurrence.
23 Place or position of ship at time of occurrence.
24 Approximate quantity and type of oil.
25 Circumstances of discharge or escape, the reasons there for and general remarks.
26 Bunkering:
.1 Place of bunkering.
.2 Start and stop date and time of bunkering.
.3 Type and quantity of fuel oil and identity of tank(s) (state quantity added,
in tons, m3, gals., or bbls., and total content of tank(s)).
.4 Type and quantity of lubricating oil and identity of tank(s) (state quantity added,
in tons, m3, gals., or bbls., and total content of tank(s)).
NOTES:
1
In case of discharge or disposal of bilge water from holding tank(s), state identity and capacity of holding tank(s) and
quantity retained in holding tank.
2
The ship’s master should obtain from the operator of the reception facilities, which includes barges and tank trucks, a
receipt or certificate detailing the quantity of tank washings, dirty ballast, residues or oily mixtures transferred, together with
the time and date of the transfer. This receipt or certificate, if attached to the Oil Record Book Part I, may aid the master of
the ship in proving that the ship was not involved in an alleged pollution incident. The receipt or certificate should be kept
together with the Oil Record Book Part I.
3
The condition of the oil filtering equipment covers also the alarm and automatic stopping devices, if applicable.
11 | P a g e
EXAMPLES
11.2
11.1 / Sludge Tank #12 5.0 m 3
4.4m 3
11.2
11.3 Total Retained on Board 26.1m 3
11.4 Weekly Total of Manual Transfers 0.68m3
M.A. Carroll
_John Cate_______
Signature of Master
12 | P a g e
EXAMPLES
sump
12.4 Transferred to Sludge Tank #6, Ret.
24.2m3
M.A. Carroll
EXAMPLE: SLUDGE TRANSFER
11-OCT-2010 C 12 0.5 m3 (3 drums) sludge from cleaning
#4 Collection Tank, Ret.: 0.00 m3
12.1 Landed, Providence, RI
M. Walter
EXAMPLE: SLUDGE TRANSFER
11-OCT-2010 C 12 2.6 m3 from HFO Sludge Tk, Ret.: 0.1 m3
12.2 To no 1 Waste Oil Tk, Ret.: 9.1m3
M. Walter
_John Cate_______
Signature of Master
13 | P a g e
EXAMPLES
_John Cate_______
Signature of Master
14 | P a g e
EXAMPLES
_John Cate_______
Signature of Master
15 | P a g e
EXAMPLES
_John Cate_______
Signature of Master
16 | P a g e
EXAMPLES
Name of Ship M/V ALL SHIPS
Official Number 413567_________________
_John Cate_______
Signature of Master
17 | P a g e
IDENTIFICATION OF SHIP’S TANKS
Name of Ship____________________________________________________________
ENGINE ROOM
18 | P a g e
OIL RECORD BOOK
PART II – Cargo / Ballast Operations
(Oil Tankers)
Each oil tanker of 150 gross tons and above or a non oil tanker that carries 200 cubic meters (m3) or more of oil in
bulk, shall also maintain an Oil Record Book Part II (Cargo/Ballast Operations) in addition to an Oil Record Book
Part I. 33 CFR 151.25 (a)
The following pages of this section show a comprehensive list of items of cargo and ballast operations which are,
when appropriate, to be recorded in the Oil Record Book Part II in accordance with regulation 36 of Annex I to
MARPOL 73/78 and implemented in 33 CFR 151.25. The items have been grouped into operational sections. each
of which is denoted by a code letter.
When making entries in the Oil Record Book Part II, the date, operational code and item number shall be inserted
in the appropriate columns and the required particulars shall be recorded chronologically in the blank spaces. Each
operation shall be fully recorded without delay so that all the entries in the book appropriate to that operation are
completed. Each operation should be dated in the dd-MONTH-yyyy format (e.g. 20- JAN-2011). Each
Completed operation shall be entered and signed by the officer/person or officers/persons in charge of the
operations concerned and each completed page shall be signed by the master of the ship.
In respect of the oil tankers engaged in specific trades in accordance with regulation 2.5 of Annex I of MARPOL
73/78, appropriate entry in the Oil Record Book Part II shall be endorsed by the competent port State authority.
(This sentence should only be inserted for the Oil Record Book of a tanker engaged in a specific trade.)
The Oil Record Book Part II contains many references to oil quantity. The limited accuracy of tank measurement
devices, temperature variations and c1ingage will affect the accuracy of these readings. The entries in the Oil
Record Book Part II should be considered accordingly. All quantities should be consistently recorded
throughout the Oil Record Book as cubic meters (m3), gallons (gals), or barrels (bbls).
In the event of accidental or other exceptional discharge of oil, a statement shall be made in the Oil Record Book
Part II of the circumstances of, and the reasons for, the discharge.
Any failure of the oil discharge monitoring and control system shall be noted in the Oil Record Book Part II.
The entries in the Oil Record Book Part II, for ships holding an IOPP Certificate, shall be in English.
The Oil Record Book Part II shall be kept in such a place as to be readily available for inspection at all reasonable
times and, except in the case of unmanned ships under tow, shall be kept on board the ship. It shall be preserved
for a period of three years after the last entry has been made.
The competent authority of the Government of a Party to the Convention may inspect the Oil Record Book Part II
on board the ship to which Annex I applies while the ship is in its port or offshore terminals and may make a copy
of any entry in that book and may require the master of the ship to certify that the copy is a true copy of such entry.
Any copy so made which has been certified by the master of the ship as a true copy of an entry in the Oil Record
Book Part II shall be made admissible in any juridical proceedings as evidence of the facts stated in the entry. The
inspection of an Oil Record Book Part II and taking of a certified copy by the competent authority under this
paragraph shall be performed as expeditiously as possible without causing the ship to be unduly delayed.
19 | P a g e
LIST OF ITEMS TO BE RECORDED
PART II – Cargo / Ballast Operations
NOTES:
1
When an individual tank has more machines than can be operated simultaneously, as described in the Operations and
Equipment Manual, then the section being crude oil washed should be identified, e.g. No. 2 center, forward section.
2
In accordance with the Operations and Equipment Manual, enter whether single-stage or multi-stage method of washing is
employed. If multi-stage method is used, give the vertical arc covered by the machines and the number of times that arc is
covered for that particular stage of the program.
3
If the programs given in the Operations and Equipment Manual are not followed, give the reasons under Remarks.
20 | P a g e
(F) BALLASTING OF DEDICATED CLEAN BALLAST TANKS (CBT TANKERS ONLY)
20. Identity of tank(s) ballasted.
21. Position of ship when water intended for flushing, or port ballast was taken to dedicated
clean ballast tank(s).
22. Position of ship when pump(s) and lines are flushed to slop tank.
23. Quantity of oily water which, after line flushing, is transferred to the slop tank(s) or cargo
tank(s) in which slop is preliminarily stored (identify tank(s)). State the total quantity, in m3, gals., or bbls.
24. Position of ship when additional ballast water was taken into dedicated clean ballast tank(s).
25. Time and position of ship when valves separating the dedicated clean ballast tanks from
cargo and stripping lines were closed.
26. Quantity of clean ballast taken on board in m3, gals., or bbls.
NOTES:
1
This includes hand hosing, machine washing and/or chemical cleaning. Where chemically cleaned, state the chemical
concerned and amount used.
2
Ships' masters should obtain from the operator of the reception facilities which include barges and tank trucks, a receipt
or certificate detailing the quantity of tank washings, dirty ballast, residues or oily mixtures transferred, together with the
time and date of the transfer. This receipt or certificate, if attached to the Oil Record Book Part II, may aid the master of
the ship in proving that this ship was not involved in an alleged pollution incident. The receipt or certificate should be kept
together with (I)
theDISCHARGE
Oil Record Book OFPart II.
WATER FROM SLOP TANKS INTO THE SEA
41. Identify slop tank(s).
42. Time of settling from last entry of residues, or
43. Time of settling from last discharge.
44. Time and position of ship at start of discharge.
45. Ullage of total contents at start of discharge.
46. Ullage of oil/water interface at start of discharge.
47. Bulk quantity discharged, in m3, gals., or bbls. and rate of discharge, in m3/hour, gal/hour, or bbl/hour.
48. Final quantity discharged, in m3, gals., or bbls. and rate of discharge, in m3/hour, gal/hour, or bbl/hour.
49. Time and position of ship on completion of discharge.
50. Was the discharge monitoring and control system in operation during the
discharge?
51. Ullage of oil/water interface on completion of discharge, in meters or feet.
52. Ship's speed(s) during discharge.
53. Was a regular check kept on the effluent and the surface of the water in the
21 | P a g e
locality of the discharge?
54. Confirm that all applicable valves in the ship's piping system have been closed
on completion of discharge from the slop tanks.
(J) COLLECTION, TRANSFER AND DISPOSAL OF RESIDUES AND OILY MIXTURES NOT
OTHERWISE DEALT WITH
55. Identity of tank(s).
56. Quantity transferred or disposed of from each tank. (State the quantity retained, in m3, gals., or bbls.).
57. Method of transfer or disposal:
.1 Disposal to reception facilities (identify port and quantity involved); (identify port and quantity
involved in m3, gals., or bbls.);1
.2 Mixed with cargo (Including transfer from machinery space oil residue (sludge) and oily bilge water
tanks (identify tank(s); state quantity transferred and total quantity in tank(s),) (state quantity in m3,
gals., or bbls.);
.3 Transferred to or from (an)other tank(s) including transfer from machinery space oil residue
(sludge) and oily bilge water tanks (identify tank(s); state quantity transferred and total quantity in
tank(s), in m3, gals., or bbl);
.4 Other method (state which); state quantity disposed of, in m3, gals., or bbls.
(L) DISCHARGE OF BALLAST FROM DEDICATED CLEAN BALLAST TANKS (CBT TANKERS
ONLY)
NOTES:
1
Ships' masters should obtain from the operator of the reception facilities which include barges and tank trucks, a receipt
or certificate detailing the quantity of tank washings, dirty ballast, residues or oily mixtures transferred, together with the
time and date of the transfer. This receipt or certificate, if attached to the Oil Record Book Part II, may aid the master of the
ship in proving that this ship was not involved in an alleged pollution incident. The receipt or certificate should be kept
together with the Oil Record Book Part II.
22 | P a g e
75. Approximate quantity, in m3, gals., or bbls., and type of oil.
76. Circumstances of discharge or escape, the reasons therefore and general remarks.
23 | P a g e
IDENTIFICATION OF SHIP’S TANKS
Name of Ship____________________________________________________________
Identification of
Ship’s Tanks Capacity
PUMP ROOM
24 | P a g e
EXAMPLES
Name of Ship M/V OIL TANKER
Official Number 703393_________
CARGO/BALLAST
CARGO/BALLAST OPERATIONS
OPERATION (Oil Tanker) / MACHINERY SPACE OPERATIONS (All Ships)
Thomas Carroll________
Signature of Master
25 | P a g e
EXAMPLES
Name of Ship M/V OIL TANKER
Official Number 703393_________
CARGO/BALLAST OPERATIONS
CARGO/BALLAST (Oil Tanker) /
OPERATIONS MACHINERY SPACE PERATIONS
_Thomas Carroll__________
Signature of Master
26 | P a g e
EXAMPLES
Name of Ship M/V OIL TANKER
Official Number 703393_________
CARGO/BALLAST OPERATIONS
CARGO/BALLAST (Oil Tanker) /
OPERATIONS MACHINERY SPACE PERATIONS
S. Williams
_Thomas Carroll__________
Signature of Master
27 | P a g e
EXAMPLES
Name of Ship M/V OIL TANKER
Official Number 703393_________
CARGO/BALLAST OPERATIONS
CARGO/BALLAST (Oil Tanker) /
OPERATIONS MACHINERY SPACE PERATIONS
_Thomas Carroll__________
Signature of Master
28 | P a g e
EXAMPLES
Name of Ship M/V OIL TANKER
Official Number 703393_________
CARGO/BALLAST OPERATIONS
CARGO/BALLAST (Oil Tanker) /
OPERATIONS MACHINERY SPACE PERATIONS
_Thomas Carroll__________
Signature of Master
29 | P a g e
Supplementary Information
LIST OF OILS*
(Appendix I to Annex I of MARPOL 73/78)
Oils: Gasolines:
Clarified Casinghead (natural)
Crude oil Automotive
Mixtures containing crude oil Aviation
Diesel oil Straight run
Fuel oil No. 4 Fuel oil No. 1 (kerosene)
Fuel oil No. 5 Fuel oil No. 1-D
Fuel oil No. 6 Fuel oil No. 2
Residual Fuel oil Fuel oil No. 2-D
Road oil
Transformer oil
Aromatic oil (excluding vegetable oil) Jet Fuels:
Lubricating oils and Blending stocks JP - 1 (kerosene)
Mineral oil JP-3
Motor oil JP-4
Penetrating oil JP - 5(kerosene, heavy)
Spindle oil Turbo fuel
Turbine oil Kerosene
Mineral Spirit
Distillates: Naptha:
Straight run Solvent
Flashed feed stocks Petroleum
Heartcut Distillate oil
Gas Oil:
Cracked
*This list of oils is not meant to be comprehensive, but suggest the most common types of oil carried.
30 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
31 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
32 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
33 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
34 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
35 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
36 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
37 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
38 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
39 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
40 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
41 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
42 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
43 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
44 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
45 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
46 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
47 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
48 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
49 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
50 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
51 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
52 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
53 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
54 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
55 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
56 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
57 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
58 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
59 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
60 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
61 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
62 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
63 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
64 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
65 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
66 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
67 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
68 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
69 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
70 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
71 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
72 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
73 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
74 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
Whoever in any matter within the jurisdiction of executive, legislative, or judicial branch of the Government of the U.S. knowingly and willfully
falsifies, conceals or covers up by any trick scheme or device a material fact, or makes any false, fictitious or fraudulent statement or
representation or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry
shall be fined under this title or imprisoned not more than 5 years or both (18 U.S.C. 1001).
75 | P a g e
Name of Ship___________________________________________________________
(Circle one)
CARGO / BALLAST OPERATIONS (Oil Tankers) / MACHINERY SPACE OPERATION (All Ships)
76 | P a g e
This page is intentionally left blank
77 | P a g e
This page is intentionally left blank
78 | P a g e