CG-5352A IOPP Certificate Form A

OMB APPROVAL 1625-0041

FORM A
SUPPLEMENT TO THE

INTERNATIONAL OIL POLLUTION PREVENTION CERTIFICATE
(IOPP CERTIFICATE)
Record of Construction and Equipment for Ships other than Oil Tankers
in respect of the provisions of Annex I of the

INTERNATIONAL CONVENTION FOR THE
PREVENTION OF POLLUTION FROM
SHIPS, 1973
as modified by the Protocol of 1978, relating thereto,
(hereinafter referred to as "the Convention").
Notes:
1. This form is to be used for the third type of ship as categorized in the IOPP Certificate, i.e."ships other than any of the above".
For oil tankers and ships other than oil tankers with cargo tanks coming under regulation 2.2 of Annex I of the Convention,
Form B shall be used.
2. This Record shall be permanently attached to the IOPP Certificate. The IOPP Certificate shall be available on board the ship at
all times.
3. If the language of the original Record is neither English nor French nor Spanish, the text shall include a translation into one of
these languages.
4. Entries in boxes shall be made by inserting either a cross (x) for the answers "yes" and "applicable" or a
dash (-) for the answers "no" and "not applicable" as appropriate.
5. Regulations mentioned in this Record refer to regulations of Annex I of the Convention and resolutions refer to those adopted
by the International Maritime Organization.

1. Particulars of ship:
1.1
1.2
1.3
1.4
1.5
1.5.1
1.5.2
1.5.3
1.6
1.6.1
1.6.2
1.6.3
1.7

Name of ship:
Distinctive number or letters:
Port of registry:
Gross tonnage:
Date of build:
Date of building contract:
Date on which keel was laid or ship was at a similar stage of construction:
Date of delivery:
Major conversion (if applicable):
Date of conversion contract:
Date on which conversion was commenced:
Date of completion of conversion:
The ship has been accepted by the Administration as a "ship delivered on or before 31 December
1979" under regulation 1.28.1 due to unforeseen delay in delivery.

An agency may not conduct or sponsor, and a person is not required to respond to, a collecton of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 20 minutes. You may submit any comments concerning the accuracy of this burden estimate or any suggestions for
reducing the burden to: Commandant (CG-3PCV), U.S. Coast Guard, Washington, DC 20593-0001 or Office of Management and Budget, Paperwork Reduction Project (1625-0041),
Washington DC 20503.

U.S. Dept. of Homeland Security, USCG, CG-5352A (Rev. 01-07)
PREVIOUS EDITIONS ARE OBSOLETE

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FORM A, SUPPLEMENT TO THE
INTERNATIONAL OIL POLLUTION PREVENTION CERTIFICATE
2. Equipment for the control of oil discharge from machinery space bilge and
oil fuel tanks (regulations 12A, 14 and 16):
2A.1

The ship is required to be constructed according to the regulation 12A and complies with the
requirements of:
paragraphs 6 and either 7 or 8 (double hull construction)
paragraph 11 (accidental oil fuel outflow performance).

2A.2

The ship is not required to comply with the requirements of regulation 12A.

2.1 Carriage of ballast water in oil fuel tanks:
2.1.1 The ship may under normal conditions carry ballast water in oil fuel tanks
2.2 Type of oil filtering equipment fitted:
2.2.1 Oil filtering (15 ppm) equipment (regulation 14.6)
2.2.2

Oil filtering (15 ppm) equipment with alarm and automatic stopping device
(regulation 14.7)

2.3 Approval standards:*
2.3.1 The separating/filtering equipment :
.1 has been approved in accordance with resolution A.393(X);
.2 has been approved in accordance with resolution MEPC.60(33);
.3 has been approved in accordance with resolution MEPC.107(49);
.4 has been approved in accordance with resolution A.233(VII);
.5 has been approved in accordance with national standards not based
upon resolution A.393(X) or A.233(VII);
.6 has not been approved
2.3.2

The process unit has been approved in accordance with resolution A.444(XI)

2.3.3

The oil content meter:
.1 has been approved in accordance with resolution A.393(X);
.2 has been approved in accordance with resolution MEPC.60(33);

2.4

.3 has been approved in accordance with resolution MEPC.107(49);
Maximum throughput of the system is
m3 /h.

2.5

Waiver of regulation 14:

2.5.1

The requirements of regulation 14.1 or 14.2 are waived in respect of the ship in
accordance with regulation 14.5.
2.5.1.1 The ship is engaged exclusively on voyages within special area(s)

2.5.1.2

The ship is certified under the International Code of Safety for High-Speed Craft and
engaged on a scheduled service with a turn-around time not exceeding 24 hours.

* Refer to the Recommendation on international performance and test specifications of oily-water separating equipment and oil content meters adopted by the Organization
on 14 November 1977 by resolution A.393(X), which superseded resolution A.233(VII). Further reference is made to the Guidelines and specifications for pollution
prevention equipment for machinery space bilges adopted by the Marine Environment Protection Committee of the Organization by resolution MEPC.60(33), which,
effective on 6 July 1993, superseded resolutions A.393(X) and A.444(XI) and the revised Guidelines and specifications for pollution prevention equipment for machinery
spaces of ships adopted by the Marine Environment Protection Committee of the Organization by resolution MEPC.107(49) which, effective on 1 January 2005,
superseded resolutions MEPC.60(33), A.393(X) and A.444(XI).
U.S. Dept. of Homeland Security, USCG, CG-5352A (Rev. 01-07)

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FORM A, SUPPLEMENT TO THE
INTERNATIONAL OIL POLLUTION PREVENTION CERTIFICATE
2.5.2

The ship is fitted with holding tank(s) for the total retention on board of all oily bilge
water as follows:
Tank
Identification

Tank Location
Frames (from) - (to)

Volume (m3 )

Lateral Position

0.00 m3

Total Volume:

3. Means of retention and disposal of oily residues (sludge) (regulation 12) and bilge water holding
tank(s)*
3.1

The ship is provided with oil residue (sludge) tanks as follows:
Tank
Identification

Tank Location
Frames (from) - (to)

Volume (m3 )

Lateral Position

0.00 m3

Total Volume:

3.2 Means for the disposal of residues in addition to the provisions of sludge tanks:
l/h
3.2.1 Incinerator for oil residues, capacity
3.2.2

Auxiliary boiler suitable for burning oil residues

3.2.3
3.2.4

Tank for mixing oil residues with fuel oil, capacity
Other acceptable means:

3.3

m3

The ship is provided with holding tank(s) for the retention on board of oily bilge water as follows:
Tank
Identification

Tank Location
Frames (from) - (to)

Lateral Position

Total Volume:

*

Volume (m3)

0.00 m3

Bilge water holding tank(s) are not required by the Convention, entries in the table under paragraph 3.3 are voluntary.

U.S. Dept. of Homeland Security, USCG, CG-5352A (Rev. 01-07)

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FORM A, SUPPLEMENT TO THE
INTERNATIONAL OIL POLLUTION PREVENTION CERTIFICATE
4. Standard discharge connection (regulation 13):
4.1 The ship is provided with a pipeline for the discharge of residues from machinery bilges to
reception facilities, fitted with a standard discharge connection in accordance with
regulation 13
5. Shipboard oil/marine pollution emergency plan (regulation 37):
5.1 The ship is provided with a shipboard oil pollution emergency plan in
compliance with regulation 37
5.2 The ship is provided with a shipboard marine pollution emergency plan in compliance
with regulation 37.3
6. Exemption:
6.1 Exemptions have been granted by the Administration from the requirements of chapter 3 of
Annex I of the Convention in accordance with regulation 3.1 on those items listed under
paragraph(s) :

of this Record.
7. Equivalents (regulation 5):
7.1

Equivalents have been approved by the Administration for certain requirements of Annex I
listed under paragraph(s):

of this Record.
THIS IS TO CERTIFY that this Record is correct in all respects.
Issued at:
Place of issue of the Record

Date of issue

U.S. Dept. of Homeland Security, USCG, CG-5352A (Rev. 01-07)

Officer in Charge, Marine Inspection, U.S. Coast Guard

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ATTACHMENT TO THE IOPP CERTIFICATE AND FORM A SUPPLEMENT
RECORD OF CONSTRUCTION AND EQUIPMENT FOR SHIPS
OTHER THAN OIL TANKERS
IOPP CERTIFICATE - GROSS TONNAGE:
* The vessel's gross tonnage has been measured by the tonnage authorities
of the United States of America in accordance with national tonnage rules which
were in force prior to the coming of the International Convention on Tonnage
Measurement of Ships, 1969:
8 WAIVER OF REGULATION 14
The ship is waived from the requirements of Regulation 14.1 and 14.2 in accordance
with Regulation 14.5.
.1 this ship is engaged exclusively on voyages within special area(s): or
.2 this ship is certified under the International Code of Safety for High-Speed
Craft (or otherwise within the scope of this Code with regard to size and
design) engaged on a scheduled service with a turn-around time not
exceeding 24 hours and covering also non-passenger/cargo-carrying
relocation voyages for these ships
with regard to the provisions of subparagraphs .1 and .2 of section 8 above, the
following conditions shall be complied with:
.1 the ship is fitted with a holding tank having a volume adequate, to the
satisfaction of the Administration, for the total retention on board of the oily
bilge water;
.2 all oily bilge water is retained on board for subsequent discharge to reception
facilities;
.3 the Administration has determined that adequate reception facilities are
available to receive such oily bilge water in a sufficient number of ports or
terminals the ship calls at;
.4 the International Oil Pollution Prevention Certificate, when required, is
endorsed to the effect that the ship is exclusively engaged on the voyages
within special areas or has been accepted as a high speed craft for the
purpose of this regulation and the service is identified; and
.5 the quantity, time and port of the discharge are recorded in the Oil Record
Book Part 1.
9 WAIVER OF REGULATION 39
9.1

Drilling rigs shall be equipped as far as practicable with oil-water
separating/filtering equipment. The U.S. Coast Guard has determined that it is not
practicable to install oil-water separating/filtering equipment on this ship. All
platform machinery space oily wastes shall be retained on board the waste oil tank for
discharge in barrels to reception facilities:

U.S. Dept. of Homeland Security, USCG, CG-5352A-ATTACH (Rev. 01-07)

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