Report of disposal of waste

Information, which are to be reported before arrival at Port of Hirtshals:

Vessel informations

Vessel's name *

Vessel's call signal *

Vessels IMO port registration letter and number

Flag state *

Arrival informations

Expected arrival time (ETA) *

Expected departure time (ETD) *

Previous port of call *

Next port of call

Disposure informations

Last port, where operation waste was disposed of

Date

Waste for the disposal facilities at the port?

All

Some

Nothing

Starting time of disposal at arrival. Other

If all waste is to be disposed of, please fill out the relevant column.
If some or no waste is to be disposed of, please fill out the second to fifth column.

Type	Waste to be disposed of	Amount of waste that is kept on board	Maximum storage capacity available	Estimated amount of waste to be transported to the next port
Annex I
Oil-containing liquid waste in m³
Oil slop in m³
Ballast water in m³
Other (specified) in m³
Annex II
Dangerous waste in m³
Chemical residue in bulk in m³
Ballast water in m³
Other (specified) in m³
Annex IV
Sewage water in m³
Other (specified) in m³
Annex V
Fixed crew waste in kg
Household waste in kg
Other inflammable waste in kg
Annex VI
Non-inflammable waster in kg
Other (specified) in kg

These information may be used for port state control and other inspection purposes.

I confirm,
- that the above is accurate and correct, and
- that there is sufficient storage capacity on board to store waste, which is processed between this message and the next adequate port, where the waste will be disposed of.