The following information will enable the Company in co-operation
with the RO to develop a Survey Plan complying with the requirements
of the CAS.
It is essential that the Company provides, when completing
the present questionnaire, up-to-date information.
The present questionnaire, when completed, shall provide
all information and material required by the CAS.
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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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Gross tonnage:
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Deadweight (tonnes):
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Summer load line draught:
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Date of delivery:
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Category of ship:
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Date for compliance with regulation 19:
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Company:
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Report identification
reference:
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Information on access provision for close-up surveys
and thickness measurement:
The Company is requested to 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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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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| Fore Peak
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| Wing tanks
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Under
deck
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| Side
shell
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| Bottom
transverse
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| Longitudinal
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| Transverse
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| Centre tanks
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Under
deck
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| Bottom
transverse
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| Transverse
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Tank Cleaning Procedures:
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| Indicate
the frequency of the tank washing especially in way of uncoated tanks
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| Washing medium used :
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Crude oil
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: Yes/No
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Heated seawater
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: Yes/No
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Other medium (specify)
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Inert Gas System installed: Yes/No
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| Indicate average oxygen content
during inerting:
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| Details of use of the inert case
plant:
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Cargo history for the last 3 years together with indication as to whether
cargo was heated
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Ballast history for the last 3 years
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Inspections by the Company
Using a format similar to that of the table below (which
is given as an example), the Company should provide details of the
results of their inspections, for the last 3 years - in accordance
with the requirements of resolution A.744(18),
as amended, and of the CAS - on all CARGO and BALLAST tanks and VOID
spaces within the cargo area.
Spaces
(include frame numbers and p or s)
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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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Tank
History
(5)
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Cargo Centre Tanks
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Cargo Wing Tanks
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Slop
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Ballast tanks
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| Aft peak
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| Fore peak
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Miscellaneous spaces:
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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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Company:
.................................................................
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| 2) U = upper part; M = middle part; L = lower
part; C = complete
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Name/Signature:
.......................................................
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| 3) G = good; F = fair; P = poor, RC =
recoated
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Date:
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4) N = no findings recorded
Y =
findings recorded, description of findings is to be attached to the
questionnaire
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5) DR = Damage & Repair
L =
Leakages
CV = Conversion
CPS = Corrosion
protection system (reports to be attached)
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Reports of port State control inspections
| List the reports of port State
control of inspection containing hull related deficiencies and relevant
information on 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 of the Thickness Measurement (TM) firm