| Vessel Name | IMO Number | ||
|---|---|---|---|
| Flag | Call Sign |
| Date | Location/Latitude | Location/Longitude | |||
|---|---|---|---|---|---|
| Port of Departure | Port of Arrival | Voyage Number |
| Date | Operation Type (e.g., uptake, discharge, exchange) |
Tank(s) Involved | Quantity (m3) | Ballast Source/Location | Ballast Destination/Location | Method | Signature |
|---|---|---|---|---|---|---|---|
| Remarks / Observations |
|---|