Section 85

Date, signature and stamp of port authority official.

2790

9th. SEPTEMBER/ 2008

Name of ship ..................................................................................... .

Distinctive number or letters ................................................................. .

CARGO/BALLAST OPERATIONS (OILTANKES)

Date

Code

Item

Record of operations/signature

(letter}

(number)

of officer in charge

I i

Signature of master ................................. .

2791