IMPRIMIR BORRAR
4376 (OPT) AUTORIDAD DEL CANAL DE PANAMÁ
Rev.10-2007
SHIP DUE
CRISTOBAL BALBOA
Name of vessel Call Letters Type: Tanker
Cargo Passenger
Agent Customer Code By Date
A. Panama Canal Ship No.
B. 96-hour advance ETA
Vessel for Transit or Local
C. Draft of vessel, fore and aft. Tropical Fresh Water
D. Changes in Vessel's name, Country of registry, structure or use of tanks since last arrival
E. Whether docking at Balboa or Cristobal and reason therefore, i.e. cargo operations fuel, water,
etc., listing amounts in tons in each case
F. Nature and tonnage of deck cargo
Exceed ACP Visibility Yes No
G. 1. Is the vessel carrying any explosives or dangerous cargos in bulk? If yes, state technical name,
quantity (metric tons), flash point of petroleum or chemical products, U.N. number, and
IMO class and division for each dangerous cargo carried.
2. Petroleum or chemical tankers or bulk liquid carriers:
In ballast? Yes No Inerted? Yes No
Gas free? Yes
Yes Telex from Master indicating that cargo tanks(including slop) are safe
for entry/hot work.
No State type, flash point, U.N. number, name, of the last cargo(es)
3. Tanker & Bulk Carriers reporting "Golf: Negat"shall, in addition, state the technical names of
allon-dangerous cargos carried.
H. Is the vessel carrying any packaged dangerous goods other than explosives? If yes, state the IMO
class and division, total quantity(metric tons), with each class
I. (1) Radio Pratique Requested Yes No
(2) Ports of call last 15
(3) Communicable disease on board?
(4) Deaths on board?
(5) Number and port of disembarking passengers
(6) Stowaways Yes No Number and origin
(7) Number, kind and origin of animals on board
(8) The country of origin of all meat, cargo or stores
(9) Ports of call this voyage, infected by food and mouth disease or rinderpest
(10) Deratting Certificate Date issued
Port
REMARKS: (Agent to indicate any information pertinent to arrival of this vessel.)
Received by Date