1 The following information will enable the owner,
in co-operation with the Administration, to develop a Survey Plan
complying with the requirements of the Guidelines. It is essential
that the owner provides, when completing the present questionnaire,
up-to-date information. The present questionnaire, when completed,
should provide all information and material required by the Guidelines.
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Particulars
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| Ship's name:
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| IMO number:
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| Flag State:
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| Port of registry:
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| Owner:
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| Recognized organization:
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| Gross tonnage:
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| Deadweight (metric tonnes):
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| Date of delivery:
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Information on access provision for close-up surveys
and thickness measurement
2 The owner should indicate, in the table below,
the means of access to the structures subject to close-up survey and
thickness measurement. A close-up survey is an examination where the
details of structural components are within the close visual inspection
range of the attending surveyor, i.e., preferably within reach of
hand.
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Hold/Tank No.
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Structure
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Temporary staging
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Rafts
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Ladders
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Direct access
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Other means (please specify)
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| F.P.
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Fore peak
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| A.P.
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Aft peak
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| Cargo holds
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Hatch side coamings
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| Topside sloping plate
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| Upper stool plating
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| Cross deck
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| Double-side tank plating
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| Transverse bulkhead
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| Hopper tank platting
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| Lower stool
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| Tank top
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| Topside tanks
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Under deck structure
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| Side shell and structure
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| Sloping plate and structure
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| Webs and bulkheads
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| Hopper tanks
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Hopper sloping plate and structure
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| Side shell and structure
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| Bottom structure
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| Webs and bulkheads
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| Double-side tanks
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Side shell and structure
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| Inner skin and structure
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| Webs and bulkheads
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Double bottom structure
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Upper stool internal structure
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Lower stool internal structure
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| Wing
tanks of double ore carriers
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Under deck and structure
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| Side shell and structure
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| Side shell vertical web and structure
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| Longitudinal bulkhead and structure
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| Longitudinal bulkhead web and structure
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| Bottom plating and structure
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| Cross ties/stringers
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History of bulk cargoes of a corrosive nature (e.g., high sulphur
content)
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3 Using a format similar to that of the table
below (which is given as an example), the owner should provide details
of the results of their inspections, for the last 3 years −
in accordance with the Guidelines − on all CARGO holds and BALLAST
tanks and VOID spaces within the cargo area.
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Tank/Hold No.
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Corrosion protection (1)
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Coating extent (2)
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Coating condition (3)
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Structural deterioration (4)
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Hold and tank history (5)
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| Cargo holds
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| Topside tanks
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| Hopper tanks
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| Double-side skin tanks
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| Double bottom tanks
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| Upper stools
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| Lower stools
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| Wing tanks (ore carriers)
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| Fore peak
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| Aft peak
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| Miscellaneous other spaces:
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Note:
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Indicate tanks which are used for oil/ballast.
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| 1) HC = hard coating; SC =
soft coating; A = anodes; NP = no protection
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| 2) U = upper part; M = middle
part; L = lower part; C = complete
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Name of owner's
representative:
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| 3) G = good; F = fair; P =
poor; RC = recoated (during the last 3 years)
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....................................................................................................................................
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| 4) N = no findings recorded; Y
= findings recorded, description of findings should be attached to this
questionnaire
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Signature:
........................................................................................................
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| 5) DR = damage and repair; L =
leakages; CV = conversion (description to be attached to this
questionnaire)
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Date
...............................................................................................................
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Reports of port State control
inspections
| List the reports of port State
control inspections containing hull structural related deficiencies,
relevant information on rectification of the deficiencies:
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Safety management system
| List non-conformities related to hull
maintenance, including the associated corrective actions:
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Name and address of the approved
thickness measurement company: