| Vessel Name | IMO Number | ||
|---|---|---|---|
| Flag | Port of Registry | ||
| Ballast Water Capacity (m³) | Voyage Number |
| Date | Time | Tank/ Hold | Operation Type (Intake/Discharge/Exchange/Treatment) |
Position (Lat/Long) | Source/Destination Port or Location | Volume (m³) | Signature/ Officer Name | Remarks |
|---|---|---|---|---|---|---|---|---|
| Name | |
|---|---|
| Signature | |
| Date |