Page 292 - Rules of Navigation2020

DECLARATION “IV”
Technical and Protection Information in Respect of Consignments of
Group 2 Radioactive Substances on Vessels Transiting SC
(Page 1)

(All items must be completed. If any of the items in this statement is not
applicable, the letters “N.A.” should be inserted )

Name of vessel : …………………… Nationality : ………………………

Master’s Name : ……………………

Port of entry : …………………... Date of transit : ……………….....

Port of loading : …………………… Port of destination : …………....

(1) Regulations according to which the packing is prepared for transportation.

(2) Appropriate information related to the radioactive material :
a) Material and group …………………………………………………

b) Activity in M.C. per package ………………………………………

c) Physical and chemical state ………………………………………...

d) Max. temp. at the surface of the package during transport …………

(1)
e) Encapsulated state .
(3) Required information on packages characteristics. (Similar packages with

same contents should be mentioned together with indication of their marks

and serial numbers):

a) Marks and serial number …………………………………………..

b) Type of packing ……………………………………………………

c) Packing category …………………………………………………..

d) Dimensions in cm ( indicate whether it is large radioactive source ).
e) Weight ……………………………………………………………..

1 ) If encapsulated state, indicate date and competent authority which approved the encapsulation.

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