危险货物安全适运申报单-样表
危险货物安全适运申报单
Declaration on Safety and Fitness of Dangerous Goods
(散装液体物质) (Bulk Liquids)
发货人(名称、地址) :
Shipper ( name,address ) :
甲公司
货物种类 (在相应的方框内填上“×”)
Kinds of goods ( Insert “×”in appropriate box ):
×散化 □液化气 □散装油类
Bulk chemical Liquefied gas Bulk oil
装卸港:上海/××码头
Port of Loading: 承运人名称(或其代理人): Carrier ( or its agent ) : 乙公司 船名和航次 : Ship’s name & Voyage NO. : X2/121W 卸货港:神户
Port of Discharging :
正确运输名称※;污染物类别;危规编号;数量;闪点(闭杯);可燃上下限;自燃温度;沸点;液体相对密度;蒸气密度;蒸气压力(20℃/37.8℃) ;水中溶解度;粘度;酸度;TL V (ppm ),LC 50;LC 50(口服/皮肤) ;导电率(ps/m);液化温度和压力
Proper Shipping Name※;IMO pollution Category; UN No; Quantity; Fiash Point(closed cup);Flammability Limits; Autoignition Temperature; Boiling Point; Relative Density of Liquid; V apour Pressure; Solubility in Water; Viscosity; Acidity; TL V(ppm);LC50;LD 50(oral/skin);Conductivity(ps/m);Temperature & Pressure of Liquefaction
正确运输名称:丙烯腈;污染物类别:Y ;危规编号:1093;数量:1000吨;
闪点:-5℃;可燃上下限2.8%~28%;自燃温度480℃;沸点77.3℃;
液体相对密度0.81;蒸气密度1.83;微溶于水;粘度12MPAS ;TLV :2ppm,
LC50:口服78 mg/kg /皮肤250 mg/kg
注:以上货物特性根据货物种类填写合适项目。
Remarks : Please fill in the proper columns with cargo properties ※不能仅使用贸易或专利名称
According to the cargo classification. Proprietary / trade names alone are not sufficient. 附加资料:添加剂证明
Additional information:
货物反应性:
Reactivity of the cargo :
与硫、碱、强氧化剂、氨类等不相容。本身有自聚危险, 应避热、避光; 储存温度低于30℃
应急措施(溢漏需采取的措施、有效灭火剂、其它应急措施):
Emergency measures (The measures taken for spill, effective fire extinguishing agent and other emergency measures):
溢漏需采取的措施:少量用吸收材料吸收; 大量围提或挖坑围护后用防爆泵抽入备用容器中集中处理。
消防措施:二氧化碳、干粉、抗溶性泡沫
人员防护:
Personnel Protection:
穿戴防护服和自给式呼吸器
声明:
已按规定全部并准确地填写了上述拟交付船舶载运的危险货物的正确运输名称、危规编号、危
险特性等应申报事项、货物在各方面均符合安全适运条件。以上申报准确无误。
Declaration:
I hereby declare that the declaration is fully and accurately dexcribed above by the proper shipping
name, UN No., hazards property, etc. The goods is in all respects in good condition for transport by sea.
申报员姓名:××× 申报单位名称(签章)
Declarer(signature): Name of Declare Unit (seal )]
申报人员培训编号:××××× 填报日期:××年××月××日
No.: Applying Date:
紧急联系人姓名、电话、传真、电子邮箱:××× 电话:123456 传真:654321 电子邮件:××@××. ××
Emergency Contact Person’s Name, Tel, Fax and E-mail :
此申报单一式三份,其中两份申报人留持和分送承运船舶,一份留主管机关存查。
This declaration should be made in tripartite, one is kept by the Administration for file, and two for the declarer and the ship respectively. 主管机关签注栏: Remarks by the Administration: