Ballast Water Reporting Form
Ballast Water Reporting Form
4. BALLAST WATER HISTORY: RECORD ALL TANKS THAT WILL BE DEBALLASTED IN PORT STATE OF ARRIVAL; IF NONE GO TO No. 5.
Tanks/ BALLAST WATER SOURCE BALLAST WATER EXCHANGE BALLAST WATER DISCHARGE
Holds Circle one: Empty/Refill or Flow Through
(List multiple DATE Port or Volume Temp DATE/TIME Endpoint Volume % Exch. Sea DATE Port or Volume Salinity
sources per DDMMYY Lat/Long (units) (units) DDMMYY Lat/Long . (un its) Hgt.(m) DDMMYY Lat/Long (units) (units)
tank separately) M3 c M3 M3
FPT 23111 120 MUND RA 3174.7 22 NIA NIA NIA NIA NIA NIA NIA NIA 1. 020
WBT IPIS 2311 1120 MUND RA 4308 22 NIA NIA NIA NIA NIA NIA NIA NIA 1.020
WBT2PIS 2311 1120 MUND RA 11 397.8 22 NIA NIA NIA NIA NIA NIA NIA NIA 1.020
WBT3PIS 23/1 1120 MUND RA 11 583.8 22 NIA NIA NIA NIA NIA NIA NIA NIA 1. 020
WBT4PIS 2311 1120 MUND RA 11532 22 NIA NIA NIA NIA NIA NIA NIA NIA 1.020
WBT 5PIS 23/1 1120 MUNDRA I 0461.8 22 NIA NIA NIA NIA NIA NIA NIA NIA 1.020
APT 23/11 120 MUND RA 512.4 22 NIA NIA NIA NIA NIA NIA NIA NIA 1.020
CHNO. 6 24/11/20 MUND RA 19387.98 22 NIA NIA NIA NIA NIA NIA NIA NIA 1.020
Ballast Water Tank Codes: Forepeak = FP, Aft peak =AP; Double Bottom - DB; Wing=WT; Topside = TS; Cargo Hold = CH; Oth~r .:: · A--