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2 STANDARD FORMAT OF THE ADVANCE NOTIFICATION FORM FOR WASTE DELIVERY TO PORT RECEPTION FACILITIES Notification of the Delivery of Waste to: (enter name of port or terminal) The master of a ship should forward the information below to the designated authority at least 24 hours in advance of arrival or upon departure of the previous port if the voyage is less than 24 hours This form shall be retained on board the vessel along with the appropriate Oil RB, Cargo RB or Garbage RB 1. SHIP PARTICULARS DELIVERY FROM SHIPS (ANF) 1.1 Name of ship: 1.5 Owner or operator: 1.2 IMO number: 1.6 Distinctive number or letters: 1.3 Gross tonnage: 1.7 Flag State: 1.4 Type of ship: Oil tanker Chemical tanker Bulk carrier Container Other cargo ship Passenger ship Ro-ro Other (specify) 2. PORT AND VOYAGE PARTICULARS 2.1 Location/Terminal name and POC: 2.6 Last Port where waste was delivered: 2.2 Arrival Date and Time: 2.7 Date of Last Delivery: 2.3 Departure Date and Time: 2.8 Next Port of delivery (if known): 2.4 Last Port and Country: 2.9 Person submitting this form is (if other than the master): 2.5 Next Port and Country (if known): 3. TYPE AND AMOUNT OF WASTE FOR DISCHARGE TO FACILITY MARPOL Annex I Oil Quantity (m 3 ) MARPOL Annex V Garbage Quantity (m 3 ) Oily bilge water Plastic Oily residues (sludge) Oily tank washings Dirty ballast water Scale and sludge from tank cleaning Other (please specify) Floating dunnage, lining, or packing material Ground-down paper products, rags, glass, metal, bottles, crockery etc. Cargo residues 2, paper products, rags, glass, metal, bottles, crockery, etc. Food waste MARPOL Annex II NLS Quantity (m 3 1 )/Name Incinerator ash Category X substance Other wastes (specify) Category Y substance MARPOL Annex VI Air pollution Quantity (m 3 ) Category Z substance OS other substances Ozone-depleting substances and equipment containing such substances MARPOL Annex IV Sewage Quantity (m 3 ) Exhaust gas-cleaning residues 22

Name of ship: IMO Number: Please state below the approximate amount of waste and residues 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 board this vessel (as shown on page 1) at this port Type MARPOL Annex I Oil Oily bilge water Oily residues (sludges) Oily tank washings Dirty ballast water Scale and sludge from tank cleaning Other (please specify) MARPOL Annex II NLS Category X substance Category Y substance Category Z substance OS other substances MARPOL Annex IV Sewage Sewage MARPOL Annex V Garbage Plastic Floating dunnage, lining or packing material Ground paper products, rags, glass, metal, bottles, crockery Cargo residues, paper products, rags, glass, metal bottles, crockery Food waste Incinerator ash Other wastes (specify) Maximum dedicated storage capacity m 3 Amount of waste retained on board m 3 Port at which remaining waste will be delivered (if known) Estimate amount of waste to be generated between notification and next port of call m 3 Date:... Name and Position:... Time:... Signature:... 23

3 STANDARD FORMAT FOR THE WASTE DELIVERY RECEIPT FOLLOWING A SHIP S USE OF PORT RECEPTION FACILITIES (MEPC.1/Circ.645) The designated representative of the reception facility provider should provide the following form to the master of a ship that has just delivered waste. This form should be retained on board the vessel along with the appropriate Oil RB, Cargo RB or Garbage RB 1. RECEPTION FACILITY AND PORT PARTICULARS 1.1 Location/Terminal name: 1.2 Reception facility provider(s): 1.3 Treatment facility provider(s) if different from above: 1.4 Waste Discharge Date and Time from: to 2. SHIP PARTICULARS 2.1 Name of ship: 2.5 Owner or operator: 2.2 IMO number: 2.6 Distinctive number or letters: 2.3 Gross tonnage: 2.7 Flag State: 2.4 Type of ship: Oil tanker Chemical tanker Bulk carrier Container Other cargo ship Passenger ship Ro-ro Other (specify) 3. TYPE AND AMOUNT OF WASTE RECEIVED MARPOL Annex I Oil Quantity (m 3 ) MARPOL Annex V Garbage Quantity (m 3 ) Oily bilge water Oily residues (sludge) Oily tank washings Dirty ballast water Scale and sludge from tank cleaning Other (please specify) MARPOL Annex II NLS Category X substance Category Y substance Category Z substance OS other substances MARPOL Annex IV Sewage Quantity (m 3 )/Name Quantity (m 3 ) Plastic Floating dunnage, lining, or packing materials Ground paper products, rags, glass, metal, bottles, crockery Cargo residues, paper products, rags, glass, metal, bottles, crockery, etc. Food waste Incinerator ash Other wastes (specify) MARPOL Annex VI related Ozone-depleting substances and equipment containing such substances Exhaust gas-cleaning residues Quantity (m 3 ) On behalf of the port facility I confirm that the above wastes were delivered. Signature:... Full Name and Company Stamp:... 24

Щ «О Я Э О ОГИЧ Я У» (Sea Ecological Company, Ltd.) 685014,.,, 3-,.18 (3-rd floor office, Sea Commersial Port, Magadan, Russia, 685014, tel. 668-749; fax. 692-230(84132) 20.. (Statement) / (On delivery-acception of the ship generated),, / (I, the undersigned the representative of Sea Ecological Company, have registered the ship's waste products waste products and given representative to the ship) (type, ship's name, ship's owner), (handed over and it is accepted of the ship-generated) : (oily bilge water) 3 (m 3 ) (sludge) 3 (m 3 ) (oily rags) 3 (m 3 ) (sewage water) 3 (m 3 ) (garbage) 3 (m 3 ) (plastic) 3 (m 3 ) (food waste) 3 (m 3 ) (incinerator ash) 3 (m 3 ) (fluorescent lighting) (other) (ship's master) (signature),, -, - (This Statement is done in 3 copies: one for the ship's representative, another the representative registering ship's waste products) 25

4 REVISED CONSOLIDATED FORMAT FOR REPORTING ALLEGED INADEQUACY OF PORT RECEPTION FACILITIES * This format was developed and approved by the forty-second session of the Marine Environment Protection Committee In November 1998. The Master of a ship having encountered difficulties in discharging waste to reception facilities should forward the information below, together with any supporting documentation. to the administration of the flag State and, preferably, to the competent Authorities in the port State. The flag State shall notify the port State of the occurrence. SHIP'S PARTICULARS Name of ship: Owner or operator: Distinctive number or letters: IMO No: Gross tonnage: Port of' registry: Type of ship: oil tanker, chemical tanker, ferry, cruise ship, cargo ship, bulk carrier, or other (specify) 2. PORT PARTICULARS Country: Name of Port or Area: Location/Terminal Name: (e.g. berth/terminal/jetty) Name of company operating reception facility (if applicable): Unloading port, Loading port, Shipyard Date of arrival: Date of occurrence: Date of departure: 3. TYPE AND AMOUNT* OF WASTE FOR DISCHARGE TO FACILITI' * Estimated amount 3.1 Oil (MARPOL Annex I) Type of oily waste: bilge water 26

sludge from fuel oil purifier scale and slops from tanker cleaning dirty ballast water tank washings other (specify) were facilities available? Yes No costs involved 3.2 Noxious Liquid Substances (NLS) (MARPOL Annex II) Type of NLS residue/water mixture far discharge to facility from tank washings: category A substance m! category B substance m! category C substance m! other (special) m! substance is designated as solidifying or high viscosity proper shipping name of the NLS involved: were facilities available? Yes _ No costs involved 3.3 Garbage (MARPOL Annex V) Type of garbage. 1: Plastic m! 2: Floating dunnage, lining, or packing materials m! 3: Ground paper products, rags, glass, metal, bottles, crockery etc. m! 4: Paper products, rags, glass, metal, bottles, crockery, etc. m! 5 Food waste m! 6 Incinerator, ash m! other (specify) m! 27

were facilities available? Yes _ No costs involved 3.4 Other wastes 4. WAS ANY WASTE NOT ACCEPTED BY THE FACILITY? 5. INADEQUACY OF FACILITIES 5.1 Remarks on inadequacies 5.2 Location of facilities (close to the vessel, inconvenient location or vessel had to shift berth involving delay) 5.3 If you experienced a problem, with whom did you discuss this problem or report it to? 5.4 Did you give prior notification (in accordance with relevant port requirements) about the vessel's requirements for reception facilities? Yes No 5.5 Did you receive confirmation on the availability of reception facilities on arrival? Yes No 6. ANY ADDITIONAL REMARKS/COMMENTS 7. Master's signature Date 28