FORM / 5106

Vessel:

Berth:

Cargo:

Voy. No:

Port:

Date:

ULLAGE REPORT

Tank No.

Ullage

m cm

TOV Bbls

Free Water

DIP VOL

G.O.V. Us Bbls

Temp. Co/Fo

V.C.F.T. 6A/6B

G.S.V. Us. Bbls/60f

A.P.I.

S.G. At 60 F

Density 15o F

WCF tab 11/13

LT/MT

TOTALS

GROSS STANDARD VOLUME

: ……………………………

BILL OF LANDING GROSS

: ………… …BBLS

…………………...MT

……………….LT

PLUS FREE WATER

: ……………………………

SHIPS FIGURE

: …………..…BBLS

…………………...MT

……………….LT

LESS O.B.Q.

: ……………………………

DIFFERENCE

: ……………..BBLS

…………………...MT

……………….LT

TOTAL CARGO VOLUME

: ……………………………

for the Vessel Surveyor

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