Part I - For all garbage other than cargo residues as defined in regulation 1.2
(Definitions) (All ships)
| Ship's name
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Distinctive number or letters
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IMO number
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Garbage categories
| A-Plastics
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B-Food waste
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C-Domestic wastes
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D-Cooking oil
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| E-Incinerator ashes
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F-Operational wastes
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G-Animal carcasses
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H-Fishing gear
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I–E-waste
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Discharges under MARPOL Annex V regulations 4 (Discharge of garbage
outside special areas), 5 (Special requirements for discharge of garbage from fixed
or floating platforms) or 6 (Discharge of garbage within special areas) or chapter 5
of part II-A of the Polar Code
| Date/ Time
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Position of the ship (latitude/longitude)
or port if discharged ashore or name of ship if discharged
to another ship
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Category
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Estimated amount
discharged
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Estimated amount incinerated
(m3)
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Remarks: (e.g. start/stop time and position of
incineration; general remarks)
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Certification/ Signature
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| Into sea (m3)
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To reception facilities or to another ship
(m3)
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Exceptional discharge or loss of garbage under regulation 7
(Exceptions)
| Date/ Time
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Port or position of the ship (latitude/ longitude and water
depth if known)
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Category
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Estimated amount lost or discharged (m3)
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Remarks on the reason for the discharge or loss and general
remarks (e.g. reasonable precautions taken to prevent or minimize such
discharge or accidental loss and general remarks)
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Certification/ Signature
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Master's
signature:_________________________ Date:_______________
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Part II - For all cargo residues as defined in regulation 1.2 (Definitions) (Ships
that carry solid bulk cargoes)
| Ship's name
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Distinctive number or letters
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IMO number
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Garbage categories
| J- Cargo residues (non-HME)
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K- Cargo residues (HME)
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Discharges under regulations 4 (Discharge of garbage outside special
areas) and 6 (Discharge of garbage within special areas)
| Date/ Time
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Position of the ship (latitude/longitude) or
port if discharged ashore
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Category
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Estimated amount discharged
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Start and stop positions of the ship for
discharges into the sea
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Certification/ Signature
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| Into sea (m3)
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To reception facilities or to another ship
(m3)
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Master's
signature:_________________________ Date:_______________
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