Page 396 - International safety guide for oil tankers and terminals

INTERNATIONAL SAFETY GUIDE FOR OIL TANKERS AND TERMINALS

DECLARATION
---ใช้เพื่อการศึกษาเท่านั้น---
We have checked, where appropriate jointly, the items of the Check-List in accordance with the
instructions and have satisfied ourselves that the entries we have made are correct to the best of
our knowledge.
งานห้องสมุด ศูนย์ฝกพาณิชย์นาวี
We have also made arrangements to carry out repetitive checks as necessary and agreed that
those items coded ‘R’ in the Check-List should be re-checked at intervals not exceeding
_____ hours.

If, to our knowledge, the status of any item changes, we will immediately inform the other party.

For Ship For Barge

Name Name

Rank Rank

Signature Signature

Date Date
ึ
Time Time

Record of repetitive checks:

Date:

Time:

Initials for Ship:

Initials for Barge:

362 © ICS/OCIMF/IAPH 2006