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APPENDIX B 293 Appendix Form for reporting alleged inadequacy of port reception facilities for garbage 1. Country Name Of port or area Location in the port (e.g. berth/ terminal/jetty) Date of incident 2. Type and amount of garbage for discharge to facility: a. Total amount: food waste m3 cargo-associated waste m3 maintenance waste m3 other m3 b. Amount not accepted by the facility: food waste m3 cargo-associated waste m3 maintenance waste m3 other m3 3. Special problems encountered: Undue delay Inconvenient location of facilities Unreasonable charges for use of facilities Use of facility not technically possible Special national regulations Other 4. Remarks: (e.g. information received from port authorities or operators of reception facilities: reasons given concerning 2 above). 5. Ships's particulars Name of ship Owner or operator Distinctive number or letters Port of registry Number of persons on board Date of completion of form Signature of master