FORM / 5105

Vessel:		Port:
Voy.No:		Date:

ROB/OBQ Certificate

Tank No.	Oil			Free Water			Non Liquid			Total ROB/OBQ Volume
	Dip cm	* *	Volume cub. m.	Dip cm	* *	Volume cub. m.	Dip cm	* *	Volume cub. m.	CuM
TOTALS

Remarks:………………………….……………………………………………………………………………..………………………………………………………………………………………………………………………

Date:			Draught
Time:			Fwd
Aft
Trim

________________________ __________________

for the Vessel Survey

ATLANTIC UNITED MARINE INC.

Safety Management System Manual - IMO Res. A.741 (18)
Developed by	: SMS Designated Person	Authorised by	: Managing Director
Date of Initial Issue	: July 1999	Revision No / Effective Date	: 1 / 07-99
Chapter	: 7	Page	: 1

---