Ballast Water Management Form

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BALLAST WATER REPORTING FORM      

IS THIS AN AMENDED BALLAST REPORTING FORM? YES NO


1. VESSEL INFORMATION 2. VOYAGE INFORMATION 3. BALLAST WATER USAGE
AND CAPACITY
Vessel Name: GRANVILLE C McCALL Arrival Port: GURANAO Specify Units Below (m3, MT, LT, ST)
IMO Number:9264958 Arrival Date: 11/06/2018 Total Ballast Water on Board:
Owner: NMS SHIP MANAGEMENT CORP Agent: VENSEMAR Volume Units No. of Tanks in Ballast
Type: CRW Last Port: Country of Last Port: 0 m3 0
GT: 577 ORANJESTAD ARUBA Total Ballast Water Capacity:
Call Sign: HO7613 Next Port: Country of Next Port: Volume Units Total No. of Tanks on Ship
Flag: PANAMA ORANJESTAD    ARUBA 314 m3 10
4. BALLAST WATER MANAGEMENT Total No. Ballast Water Tanks to be discharged: 0
Of tanks to be discharged, how many: Underwent Exchange:      Underwent Alternative Management:     
Please specify alternative method(s) used, if any:      
If no ballast treatment conducted, state reason why not:      
Ballast management plan on board? YES NO Management plan implemented? YES NO
IMO ballast water guidelines on board [res. A.868(20)]? YES NO

5. BALLAST WATER HISTORY: Record all tanks to be deballasted in port state of arrival; IF NONE, GO TO #6 (Use additional sheets as needed)
Tanks/ BW SOURCES BW MANAGEMENT PRACTICES BW DISCHARGES
Holds
List multiple DATE PORT or VOLUME TEMP DATE ENDPOINT VOLUME % METHOD SEA DATE PORT or VOLUME SALINITY
sources/tanks DD/MM/YY LAT. LONG. (units) (units) DD/MM/YY LAT. LONG. (units) Exch (ER/FT/ HT. DD/MM/YY LAT. LONG. (units) (units)
separately ALT) (m)

                                                  ER                           
      m3 C       m3       m3 sg
                                                  ER                           
      m3 C       m3       m3 sg
                                                  ER                           
      m3 C       m3       m3 sg
                                                  ER                           
      m3 C       m3       m3 sg
                                                  ER                           
      m3 C       m3       m3 sg
                                                  ER                           
      m3 C       m3       m3 sg
                                                  ER                           
      m3 C       m3       m3 sg
Ballast Water Tank Codes: Forepeak = FP, Aftpeak = AP, Double Bottom = DB, Wing = WT, Topside = TS, Cargo Hold = CH, Other = O
6. RESPONSIBLE OFFICER’S NAME AND TITLE, PRINTED AND SIGNATURE: ELIO BRAVO Master

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