3. Article

TYPE AND AMOUNT OF WASTE FOR DISCHARGE TO FACILITY MARPOL Annex I - Oil Quantity (m3) MARPOL Annex V - Garbage Quantity (m3) Oily bilge water Plastic Oily residues (sludge) Food waste Oily tank washings Domestic waste Dirty ballast water Cooking oil Scale and sludge from tank cleaning Incinerator ash Oily cargo residues1 Operational waste Other (specify) Cargo residues2, 4 MARPOL Annex II - NLS Quantity (m3)/Name1 Animal carcass (es) Tank washings containing category X substances Fishing gear Tank washings containing category Y substances Other wastes (specify) Tank washings containing category Z substances MARPOL Annex VI - Air pollution Quantity (m3) Tank washings containing other substances Ozone-depleting substances and equipment containing such substances Prewash Exhaust gas-cleaning residues Cargo residues containing category X, Y, Z substances1 Ballast water containing category X, Y, Z substances Other (specify) MARPOL Annex IV - Sewage2 Quantity (m3) Sewage Please state below the approximate amount of waste remaining on board and the percentage of maximum storage capacity. If delivering all waste on board at this port please strike through this table and tick the box below. If delivering some or no waste, please complete all columns. I confirm that I am delivering all the waste held on the board of this vessel (as shown above) at this port ⎕ Type Maximum dedicated storage capacity m3 Amount of waste retained on board m3 Port at which remaining waste will be delivered (if known) Estimate amount of waste to be generated between notification and next port of call m3 MARPOL Annex I - Oil Oily bilge water Oily residues (sludges) Oily tank washings Dirty ballast water Scale and sludge from tank cleaning Oily cargo residues2 Other (specify) MARPOL Annex II - NLS Tank washings containing category X substances Tank washings containing category Y substances Tank washings containing category Z substances Tank washings containing other substances Prewash Cargo residues containing category X, Y, Z substance2 Ballast water containing category X, Y, Z substances Other (specify) MARPOL Annex IV - Sewage3 Sewage MARPOL Annex V - Garbage Plastic Food waste Domestic waste Cooking oil Incinerator ash Operational waste Cargo residues 2, 4 Animal carcass (es) Fishing gear Other wastes (specify) 1 Indicate the proper shipping name of the NLS involved. 2 May be estimates. 3 The corresponding boxes do not need to be completed if it is the intention to make a discharge of sewage at sea in accordance with Regulation 11 of Annex IV of MARPOL convention. 4 Indicate the proper shipping name of the dry cargo. I confirm that the above details are accurate and correct and there is sufficient dedicated on-board capacity to store all waste generated between notification and next port at which waste will be delivered. ⎕ Date: Name and position: Time: Signature: " Ministru prezidents Valdis Dombrovskis Satiksmes ministrs Anrijs Matīss