危险货物污染危害性货物安全适运声明书

危货污危性物全运明DeclarationandFitnessDangerous/（包装货物）（Packaged）进港Arrival□出港Departure

Shipper：：Ship’s&NO.:

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

Goodsdelivedas:&**、应***ifshippingname*,IMOhazard

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

Ofunit

andemergencytemperature**,identification

packagesasMARINEEmsinbulkNo.****仅使用/（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.

危货污危性物全运明DeclarationandFitnessDangerous/（散装液体物质）（Bulk）进港Arrival□/出港□

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

(its：Shipsname&:ofLoading:Portof:蒸气压（20/37.8水中粘酸TLV（ppmLC(导电（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

管签Remarks

NameDeclare(seal):

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

船舶载运污危害性货物报单DeclarationFormCarriedBy（固散污危性物（/in船名：

航次：

进港始

抵Ship’s

VoyagePortofTim国籍：

经营人：

出港作泊

装Nationality:Manager:

Berth:

Tim货物正确运输名称装运形式件数总量卸货港类性质危规编号ProperNameMeansNumberofWeightinPortofUNNo.theGoodsTransportTotalDischarging兹声明根据船舶装载污染危害性货物安全和防污染适条全容正确无误。Iherebydeclarethatinwithprovisionsofofgoodsbyandpollutionprtherequirementsofforcarryinggoods;Cargostowageaccordingofthecompleteandthecontentsofaretrue附送以下单证、资料：Thefollowingdocumentsandin船申报人员：

船代人（盖章）/船长证书编人员培训备案编号：

日期：CertificateNo:紧急联系人姓名、电话、传真、电子邮箱：EmergencyContactPersonTel,此申报单一式三份，其中两份申报人留持和分送港口作业部门，一份留主管机关存查。Thisdeclarationshouldbeintripartite,byAdministrationfortwothedeclarerport

Ship’s

船舶载运污染危害性货物申报单DeclarationFormForByShips（散装液体物质）Bulk）进抵BerthingPortofTimeof

Owner:No.DepartureTimeofLoading:货输种质ShippingNameofTheGoodsproperty

危号UNNo.

数量

液编号Numberoftanks

液化（Tank

Cargo)

卸PortofDischarging

备注Remarks舱室Tank

水质ofwater

数量Quantity

注明该舱洁压载舱或Indicatingwhethertheisballasttankorcargotank

备注Thisplanstocarryoutfollowingoperation(s)inapplicationwillbeseparatelytherelevantprovisions:）□tank(waterwash)Notankdetergent/YesoilwashingNofreeing质的洗舱、预计

）

YesNodisposalofwatersubstances/mixturestons(M

tothisship’scertificatesconcerningsafe

RemarksAdministrationallvalid’sequipmentconditionandrequirementsoffitnessgoods;documentationgoodsiscompleteand