Fo-032 R0 Bunker Data Form.doc

Name of Vessel: .......................................................               IMO No: …………………………

Name of Owner Operator: ................................................................................................

Port Bunkered: ..................................................................................................................

Date Bunkered: .................................................................................................................

Fuel Supplier’s Name: ......................................................................................................

Barge Delivery - Barge Name: ..........................................................................................

Pipeline Delivery - Terminal Name: ..................................................................................

SAMPLING DATA                (Circle and complete where indicated by ……….……………)

Sample date              : …………………………

Sampling Point              : Ships bunker line               Barge bunker line               Other …………………...

Sampling Method              : Continuous drip               Line sample taken periodically during delivery                  Automatic sampler              Other ……………………………………………..

Sample Seal Numbers:

Given to Supplier: ………              Retained Onboard/Send for Analysis: ……….               MARPOL Sample: ..........

ORDERING DATA                (Circle and complete where indicated by ……….……………)

Fuel Grade Ordered:              HFO              IFO- …………              MDO              MGO

Conforming to specification:              RM ………….              DM …………

Tick if low Sulphur Spec Ordered              LSFO (1.5%)               Low Sulphur Gas Oil (0.10%)

              Low Sulphur Gas Oil (0.20%)

              Low Sulphur Diesel (1.5%)

Fuel supplied in accordance with ISO 8217 Spec. Flash Point greater than 60.5°C

BUNKERING DATA                (Circle and complete where indicated by ……….……………)

Quantity onboard before:              ….…… m/t              Quantity bunkered: …………….. m/t

Suppliers Density   15°C:              ………. Suppliers Viscosity cST …………. °C: ………….

Supplier Sulphur Content (%) …………………………

Was fuel mixed with fuel already onboard? (Circle one)               YES              NO

              Master/Chief Engineer              Supplier’s Representative

              ……………………………              Name (print)               …………………………….

              ……………………………              Signature               …………………………….