The Exporter Must at All Times Be in Possession of This Document

THE EXPORTER MUST AT ALL TIMES BE IN POSSESSION OF THIS DOCUMENT

Request waiting quay for tankers at non-tanker quays / HKD 37 - EN
042017/1

Who fills in this form?

The company asking permission to moor tankers at non-tanker quays.

Who receives this form?

The written request should be submitted as soon as possible and no later than 24 hours (Saturdays, Sundays and legal public holidays not included) prior tothe requested date and time of mooring.
On workdays from 9:00 a.m. to 4:00 p.m.
Counter for permits: , tel. +32 3 229 68 00
If, due to unforeseen circumstances, the specified deadline cannot be met, the request may be made by phone. The requestor must immediately confirm the telephonic request in writing, stating the name of the telephone correspondent of Shipping Management and the time of the telephonic request.
After office hours, during public holidays and weekends: Dock Superintendent-Supervisors:
, tel. + 32 3 229 67 33

SHIP DETAILS

1 / Please enter below the details relating to the vessel
Name of ship
Origin/previous berth: / Location of waiting quay:
Type of tanker
Stay number
Start date / Time
End date / Time
Additional comment
Ship dimensions / L / B / D
Cargoes present (incl. UN codes)
For empty tanks: the latest cargoes (incl. UN codes)
Is the ship gas-free/inerted / Yes, with certificate from recognised gas doctor
Yes, no certificate, inert declaration to be confirmed by the master of the ship
no
Planned work (hot work, bunkering, stores, etc.)

WAITING QUAY DETAILS

2 / Specify the waiting quay details
Location (quay + concessionary)
The concessionary has been notified:
yes / Contact details
no

ADVICE SHIPPING MANAGEMENT

3 /

Advice

Not permitted
Permitted
Permitted if the following conditions in addition to those of Port Instruction 3.13. are fulfilled:

FINAL ADVICE HARBOURMASTER'S OFFICE

4 /

Final advice

Permitted
Not permitted
Permitted if the following conditions in addition to those of Port Instruction 3.13. are fulfilled:
Gas-free/inerted to be renewed every 24h by recognised gas expert
Gas-free certificate present for shifting
Inert declaration for arrival and to be confirmed immediately by recognised gas expert upon arrival at waiting quay.
Non-gas-free or no certificate by recognised gas expert
Safety zone (20 m) with recognised fire watch
Safety zone (50 m) with recognised fire watch
Recognised fire watch
No 2nd hand vehicles on the front-quay within a 20m radius
Loading operations prohibited without explicit permission from HMO
Bunkering is prohibited without explicit permission from HMO
Name and signature
HMO representative

If you are hereby granted permission to carry out the work as requested above, then the permit will be based on the information provided to the Harbourmaster's Office in the above request. Any changes to this information will automatically void the permit, and a new request will have to be submitted.

First issue date: / 11/2014 / Document: / Request waiting quay for tankers at non-tanker quays
Revision date: / 04/2017 / Reference:
Page:
Drawn up by: Marc Bosseler / Manager: / HKD/GM