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Survey Planning Questionnaire For Oil Tanker - CAS

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Ship Name :ELIXIR

BV Reg. No. :25322B

SURVEY PLANNING QUESTIONNAIRE FOR


RENEWAL SURVEYS OR CAS SURVEY OF OIL TANKER

The following information will enable the owner/Company in co-operation with the Society to develop a Survey
programme/Plan complying with the requirements of the rules or regulations for the Renewal surveys or CAS surveys
of oil tankers.

It is essential that the owner/Company provides, when completing the present questionnaire, up-to-date information.

The present questionnaire, when completed, is to provide all information and material required by the Rules or CAS.

Particulars
CAS  RENEWAL  (tick off one or both boxes as appropriate)
Ship's name: ELIXIR
IMO number: 9282510
Flag State: MARSHALL ISLANDS
Port of registry: MAJURO
Gross tonnage: 28245
Deadweight (metric tonnes): 46874
Summer load line draught: 12.802 m
Date of build/delivery: 28 June 2004
Category of ship: Oil Tanker
Date of Compliance with Marpol Annex I, regulation 19:
Owner/Company: HIGH SEAS SHIPPING LLC
Report identification reference:
Single hull  Double hull 
(Information in italic be suppressed when the CAS survey is NOT concerned)

Information on access provision for close-up surveys and thickness measurement

The owner/Company is requested to indicate, in the table below, the means of access to the structures subject to
close-up survey and thickness measurement.

A Close-up survey is an examination where the details of structural components are within the close visual
inspection range of the attending surveyor, i.e. preferably within reach of hand.

Tank n° Structure C(Cargo) Temporary Rafts Ladders Direct Other means


B(Ballast) staging access (please specify)

F.P. Fore Peak B - - - O


A.P. Aft Peak B - - - O
Wing tanks

Under deck C/B - - - O


Side shell C/B - - - O
Bottom transverse C/B - - - O
Longitudinal C/B - - - O
Transverse C/B - - - O
Center tanks

Under deck N.A


Bottom transverse N.A
Transverse N.A


Word in italic to be kept for CAS
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Ship Name :ELIXIR
BV Reg. No. :25322B

(Paragraph to be suppressed when the CAS survey is NOT concerned)


Tank Cleaning Procedures
Indicate the frequency of the tank washing especially in way of uncoated tanks :
- AFTER CARGO DISCHARGING
- BEFORE DRY DOCKING

Washing medium used : Crude oil : Yes/No


Heated seawater : Yes/No
Other medium (specify) : FRESH WATER

(Paragraph to be suppressed when the CAS survey is NOT concerned)


Inert Gas System installed : Yes/No
Indicate average oxygen content during inerting: LESS THAN 5 %
Details of use of the inert gas system: FLUE GAS PLANT

(Paragraph to be suppressed when the CAS survey is NOT concerned)


Cargo history for the last 3 years together with indication as to whether cargo was heated
NO HEATED CARGO WAS CARRIED
ONLY PETROLEUM WHITE PRODUCTS: GASOLINE, DIESEL OIL, NAFTHA, KEROSENE

(Paragraph to be suppressed when the CAS survey is NOT concerned)


Ballast history for the last 3 years
TANKS BALLASTED AFTER COMPLETED DISCHARGING OF THE VESSEL

(Paragraph to be suppressed when the CAS survey is concerned)


History of bulk cargo with H2S content or heated cargo for the last 3 years together with indication as to
whether cargo was heated and, where available, Marine Safety Data Sheets (MSDS)


Refer to resolution MSC.150(77) on Recommendation for material safety data sheets for MARPOL Annex I
cargoes and marine fuel oils.
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Ship Name :ELIXIR
BV Reg. No. :25322B

Owner/Company’s inspections

Using a format similar to that of the table below (which is given as an example), the owner/company is to provide
details of the results of their inspections, for the last 3 years – in accordance with the requirements of the Rules / of
resolution A. 744 (18) as amended and of the CAS -on all cargo and ballast tanks and void spaces within the cargo
area, including peak tank.

Coating Structural Tank


Corrosion Coating
Condition deterioration damage
Tank n° protection Extent
(3) (4) history
(2)
(1) (5)
Cargo centre tanks

Cargo wing tank


NO 1 CARGO TANK P/S HC C G N N
NO 2 CARGO TANK P/S HC C G N N
NO 3 CARGO TANK P/S HC C G N N
NO 4 CARGO TANK P/S HC C G N N
NO 5 CARGO TANK P/S HC C G N N
NO 6 CARGO TANK P/S HC C G N N
SLOP TK P/S HC C G N N

Ballast tanks
FORE PEAK TANK HC & A C G N N
NO 1 WBT P/S HC & A C G N N
NO 2 WBT P/S HC & A C G N N
NO 3 WBT P/S HC & A C G N N
NO 4 WBT P/S HC & A C G N N
NO 5 WBT P/S HC & A C G N N
NO 6 WBT P/S HC & A C G N N
AFT PEAK TANK HC & A C G N N

Miscellaneous spaces
RESIDUAL TANK HC C G N N
(PORT)

Note : Indicate tanks which are used for oil/ballast

1) HC : hard coating; SC : soft coating;


SH : Semi hard coating; A : anodes;
NP : no protection Name of owner/company’s representative : .............
2) U : upper part; M : middle part; L : lower part;
C : complete Signature : ...............................................................
3) G : good; F : fair; P : poor, RC : recoated (during
the last three years) Date : .......................................................................
4) N : no findings recorded
Y : findings recorded, description of findings is to
be attached to the questionnaire
5) D R : Damage & Repair; L : Leakages
CV : Conversion

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Ship Name :ELIXIR
BV Reg. No. :25322B

(Description to be attached to this questionnaire)

Reports of port State control inspections


(
List the reports of port State control of inspection containing hull related deficiencies and relevant information on the
deficiencies:
NIL

Safety Management System

List non-conformities related to hull maintenance, including the associated corrective actions :
NIL

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Name and address of the approved Thickness Measurement (TM) company/firm


…………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………

Confirmation that the TM Company is certified by Bureau Veritas:

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