危險(xiǎn)貨物污染危害性貨物安全適運(yùn)聲明書(shū)

危貨污危性物全運(yùn)明DeclarationandFitnessDangerous/（包裝貨物）（Packaged）進(jìn)港Arrival□出港Departure

Shipper：：Ship’s&NO.:

Consignee:ofLoading:PortDischarging:kg）**凈**、控制**weight(kg)

Goodsdelivedas:&**、應(yīng)***ifshippingname*,IMOhazard

Netweight(kg)Breakbulkidentificationdivision,group**,number(s)andpackages,flashpoint

Ofunit

andemergencytemperature**,identification

packagesasMARINEEmsinbulkNo.****僅使用/（1限**如卷第款***Ifworld””EMPTY/UNCLEANED”or“RESIDUECONTAINEDQUANTITY”offollowingandinformationsubmitted:1卷5.4.4

Typeunit:ContainerVehiclePortabletankOpen“×boxcircumstancesinformationcertificates5.4.4,volumeofIMDG

/bythe/IcontentsthisdeclarationarefullyaccuratelydescribedbythepropershippingUNNo.,ClassNo.Thepackaged,placardedinconditionfortransportby

ofDeclaration

日No.:YearMonthDatePerson’sName,:ThisdeclarationshouldmadeinisbyAdministrationforfile,twoforrespectively.

危貨污危性物全運(yùn)明DeclarationandFitnessDangerous/（散裝液體物質(zhì)）（Bulk）進(jìn)港Arrival□/出港□

Shipper(name,address)：（在相Kindsofgoods(Insert“×”appropriatebox)：□□散chemicalLiquefiedoil

(its：Shipsname&:ofLoading:Portof:蒸氣壓（20/37.8水中粘酸TLV（ppmLC(導(dǎo)電（Proper;IMOpollutionCategory;No;Quantity;cup);FlammabilityAutoignitionLiquid;apourPressure;Water;Viscosity;TLV(ppm);LC；LD(oral/skin);Conductivity(ps/m);Temperature&PressureLiquefactionRemarks:fillwithproperties

Accordingtoclassification.Proprietary/namessufficient.Additionalofthe:(Theforspill,extinguishingagentotheremergencyPersonnelProtection:物/IdeclarethedeclarationfullyaccuratelyabovebytheproperNo.,property,etc.isinrespectsgoodconditionfortransportby

管簽Remarks

NameDeclare(seal):

No.:ApplyingPersonTel,andE-mail:Thisbemadeonekeptbytheforfile,andtwothe

船舶載運(yùn)污危害性貨物報(bào)單DeclarationFormCarriedBy（固散污危性物（/in船名：

航次：

進(jìn)港始

抵Ship’s

VoyagePortofTim國(guó)籍：

經(jīng)營(yíng)人：

出港作泊

裝Nationality:Manager:

Berth:

Tim貨物正確運(yùn)輸名稱裝運(yùn)形式件數(shù)總量卸貨港類性質(zhì)危規(guī)編號(hào)ProperNameMeansNumberofWeightinPortofUNNo.theGoodsTransportTotalDischarging茲聲明根據(jù)船舶裝載污染危害性貨物安全和防污染適條全容正確無(wú)誤。Iherebydeclarethatinwithprovisionsofofgoodsbyandpollutionprtherequirementsofforcarryinggoods;Cargostowageaccordingofthecompleteandthecontentsofaretrue附送以下單證、資料：Thefollowingdocumentsandin船申報(bào)人員：

船代人（蓋章）/船長(zhǎng)證書(shū)編人員培訓(xùn)備案編號(hào)：

日期：CertificateNo:緊急聯(lián)系人姓名、電話、傳真、電子郵箱：EmergencyContactPersonTel,此申報(bào)單一式三份，其中兩份申報(bào)人留持和分送港口作業(yè)部門(mén)，一份留主管機(jī)關(guān)存查。Thisdeclarationshouldbeintripartite,byAdministrationfortwothedeclarerport

Ship’s

船舶載運(yùn)污染危害性貨物申報(bào)單DeclarationFormForByShips（散裝液體物質(zhì)）Bulk）進(jìn)抵BerthingPortofTimeof

Owner:No.DepartureTimeofLoading:貨輸種質(zhì)ShippingNameofTheGoodsproperty

危號(hào)UNNo.

數(shù)量

液編號(hào)Numberoftanks

液化（Tank

Cargo)

卸PortofDischarging

備注Remarks艙室Tank

水質(zhì)ofwater

數(shù)量Quantity

注明該艙潔壓載艙或Indicatingwhethertheisballasttankorcargotank

備注Thisplanstocarryoutfollowingoperation(s)inapplicationwillbeseparatelytherelevantprovisions:）□tank(waterwash)Notankdetergent/YesoilwashingNofreeing質(zhì)的洗艙、預(yù)計(jì)

）

YesNodisposalofwatersubstances/mixturestons(M

tothisship’scertificatesconcerningsafe

RemarksAdministrationallvalid’sequipmentconditionandrequirementsoffitnessgoods;documentationgoodsiscompleteand