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    Waste Delivery Receipt: Marpol Annex I - Oil Quantity (M) Marpol Annex V - Garbage Quantity (M)

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    Manoj Tyagi
    This form is provided by the reception facility to ship masters delivering wastes and residues. It documents the details of the delivery including the location, dates, ship particulars, types and amounts of wastes received in accordance with the relevant Annexes of MARPOL. The form is to be retained onboard along with the ship's Oil, Cargo, or Garbage Record Book and requires signature of the port facility representative to confirm receipt.

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    © All Rights Reserved
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    Waste Delivery Receipt: Marpol Annex I - Oil Quantity (M) Marpol Annex V - Garbage Quantity (M)

    Uploaded by

    Manoj Tyagi
    856 views1 page
    This form is provided by the reception facility to ship masters delivering wastes and residues. It documents the details of the delivery including the location, dates, ship particulars, types and amounts of wastes received in accordance with the relevant Annexes of MARPOL. The form is to be retained onboard along with the ship's Oil, Cargo, or Garbage Record Book and requires signature of the port facility representative to confirm receipt.

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    Garbage Certificate

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    This form is provided by the reception facility to ship masters delivering wastes and residues. It documents the details of the delivery including the location, dates, ship particulars, types and amounts of wastes received in accordance with the relevant Annexes of MARPOL. The form is to be retained onboard along with the ship's Oil, Cargo, or Garbage Record Book and requires signature of the port facility representative to confirm receipt.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    856 views1 page

    Waste Delivery Receipt: Marpol Annex I - Oil Quantity (M) Marpol Annex V - Garbage Quantity (M)

    Uploaded by

    Manoj Tyagi
    This form is provided by the reception facility to ship masters delivering wastes and residues. It documents the details of the delivery including the location, dates, ship particulars, types and amounts of wastes received in accordance with the relevant Annexes of MARPOL. The form is to be retained onboard along with the ship's Oil, Cargo, or Garbage Record Book and requires signature of the port facility representative to confirm receipt.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    WASTE DELIVERY RECEIPT

    The designated representative of the reception facility provider should provide the following form to the master of a
    ship that has just delivered wastes/residues.

    This form shall be retained on board the ship along with the appropriate Oil Record Book, Cargo Record Book or
    Garbage Record Book.

    1. RECEPTION FACILITY AND PORT PARTICULARS


    1.1 Location/Terminal name:

    1.2 Reception facility provider(s)

    1.3 Treatment facility provider(s) – if different from above:

    1.4 Waste/residue Discharge Date and Time from: to

    2. SHIP PARTICULARS
    2.1 Name of ship: 2.5 Owner or operator:

    2.2 IMO number: 2.6 Distinctive number or letters:

    2.3 Gross tonnage: 2.7 Flag State:


    2.4 Type of ship: � Oil tanker � Chemical tanker � Bulk carrier � Container
    � Other cargo ship � Passenger ship � Ro-ro � Other (specify)

    3. TYPE AND AMOUNT OF WASTES/RESIDUES RECEIVED


    MARPOL Annex I – Oil Quantity (m3) MARPOL Annex V – Garbage Quantity (m3)

    Oily bilge water A. Plastics

    Oily residues (sludge) B. Food wastes

    Oily tank washings C. Domestic wastes

    Dirty ballast water D. Cooking oil

    Scale and sludge from tank cleaning E. Incinerator ashes

    Other (please specify) F. Operational wastes

    MARPOL Annex II – NLS Quantity (m3)/Name1 G. Animal carcasses

    Category X substance H. Fishing gear

    Category Y substance I. E-waste

    Category Z substance J. Cargo residues (non-HME)2

    OS – other substance K. Cargo residues (HME)2

    MARPOL Annex IV – Sewage Quantity (m3) MARPOL Annex VI – related Quantity (m3)
    Ozone-depleting substances and
    equipment containing such substances
    Exhaust gas-cleaning residues
    On behalf of the port facility I confirm that the above wastes/residues were delivered.
    Signature: ……………………………… Full Name and Company Stamp: …………………………………………

    1
    Indicate the proper shipping name of the NLS involved.
    2
    Indicate the proper shipping name of the dry cargo.

    I:\CIRC\MEPC\01\MEPC.1-CIRC.834.Rev.1.docx

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