Permit to Transfer Liquids - Marina

Details of Proposed Transfer Operation(s)

Application / Approval to Conduct Transfer Operation(s) - Fuel & Other Liquids

** THE APPROVED PERMIT IS TO BE CARRIED BY THE OPERATOR ON SITE **

Vessel / Company Name

Berth / Location

Date of Transfer

Time of Transfer

Type of Transfer *

Ship to Ship

Ship to Shore

Shore to Ship

Shore to Shore

Type of Cargoes *

Fuel

Waste

Hydraulic Oil

Grey Water

Black Water (Sewage)

Hull / Product washings

Bilge Oil

Other

If other, please describe

Vehicle Description

Registration Number

Gross Vehicle Mass (GVM) - tonne

Fuel Type

Transfer Amount (litres)

Conditions

1. Full compliance with all applicable legislation including: --- International Marine Dangerous Goods Code --- Transport Operations (Marine Safety) Act 1994 --- Environmental Protection Act 1994 --- Transport Infrastructure Act 1994 - Port Notices --- International Safety Guide for Oil Tankers & Terminals (ISGOTT) 2. Ports North reserves the right to withdraw this approval at any time without notice

Ships Agent / Vessel Master / Contractor

-- as Agent for the Vessel, I acknowledge responsibility and liability for all directions between the Vessel Master and Transfer Contractor and accept responsibility for preventing spills or unsafe acts. -- as Master/Captain/Chief Engineer, I acknowledge responsibility and liability for all activities aboard my vessel and accept responsibility for preventing spills or unsafe acts. -- as appointed Transfer Operator/Contractor, I acknowledge responsibility and liability for all transfer procedures between the Vessel and Tanker/Containers and accept responsibility for preventing spills or unsafe acts.

Name

Company

Quicklinks

Permit to Transfer Liquids - Marina