waste-declaration-form by ashrafp

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									                                               NAMSOS PORT AUTHORITIES
                                      WASTE DECLARATION FORM
                   INFORMATION TO BE NOTIFIED BEFORE ENTRY INTO THE PORT OF NAMSOS


1.   Ship’s Name                                                       2. Ship’s IMO Number

3. Flag State                                                          4. Ship’s Agent

5. Gross Tonnage                                                       6. Number of Crew

7. ETA                                                                 8. ETD

9. Last Port of Call                                                   10. Next Port of Call

11. Last port and date where waste was discharged

12. Date of last visit to a port outside the European Economic Area (EEA)*

13. Are you delivering         □
                             all    some □    none     □of your waste into Port Reception Facilities? (tick box)
14. Type and amount of waste to be delivered to port reception facilities and/or remaining on board.
         If delivering all waste, complete second column in table below. If delivering some or no waste, complete all columns.
Type                                  Amount of       Maximum          Amount of          Port at which       Estimated amount of
                                     waste to be      dedicated     waste retained      remaining waste            waste to be
                                     delivered m³      storage        on board m³       will be delivered     generated between
                                                     capacity m³                                              this notification and
                                                                                                               next port of call m³
Waste Oils
Sludge

Bilge Water

Other
(please specify)
Garbage
Food Waste

Plastic

Non-EEA* food/galley waste
(International Catering Waste)**
Separated for recycling
(please specify)
Other
(please specify)
Cargo-associated wastes and residues
Cargo-associated waste
(please specify)
Cargo residues
(please specify)
Sewage
Untreated/partially treated
(delete as applicable)
* The European Economic Area (EEA) includes all EU Member States, in addition to Norway, Iceland and Liechtenstein.
** Food, galley waste and associated packaging generated by ships that have visited a port outside the EEA in the past 2 years


Do you treat or minimise waste on board?                   Yes   □          No   □
Type:     Oily Separator   □         Incinerator   □       Compactor   □    Recycling   □      Other ………………………

I confirm that the above details are accurate and correct and there is sufficient dedicated onboard capacity to store all waste
generated between notification and the next port at which waste will be delivered.

Signature ………………………………………….                                Date …………………………                     Time ………………………

								
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