附件:1. 熏蒸船舶通报单
2. 熏蒸警告标牌
3. 常见熏蒸气体空气中蒸气毒性浓度阈限值(TLV)
4. 船舶熏蒸剂残渣接收证明
附件1:熏蒸船舶通报单
Declaration Form By Arrival Ship under fumigation
船 名: 航 次: 始发港: 抵港时间:
Ship’s Name:________________ Voyage No.:____________
Port of Departure:_____________ Time of Arrival:____________
熏蒸剂名称Fumigant | 熏蒸日期和时间Date and time of fumigation | 使用量(kg)Amount | 包装形式Packaging | 通风日期和时间Date and time of ventilation | 熏蒸处所Place of fumigation | 熏蒸剂残渣拟处理时间Date and time of disposal |
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轮机长/申报员: 船舶/代理人(盖章)Master/ Declarer:_____________________ Ship/ Agent (Seal): ______________________船长/申报员证书编号: 日期:Certificate No: ______________________ Date:______________________ | 主管机关签注栏:Remarks by the Administration |
紧急联系人姓名、电话、传真、电子邮箱:Emergency Contact Person’s Name,Tel, Fax and E-mail: |