Certificate of Inspection
Portable Foam Applicator
Name of Vessel:
IMO Number:
Owner/Manager:
Flag:
Classification Society:
Type of Vessel:
Place of Service:
Date of Service:
Next Service:
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Herewith to confirm that the following equipment was inspected, serviced and released in working condition acc. to IMO MSC.1/Circ.1432).
Technical Information
Rows
1
2
3
4
5
Manufacturer
Model
Capacity
Foam Information
Rows
1
2
3
4
5
Foam container sealed
Location
Foam Concentration
Foam Type
Manufacturer Date
Foam Expiry Date
Comments
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Herewith to confirm that the following equipment was inspected, serviced and released in working condition acc. to IMO MSC.1/Circ.1432).
Inspection/Service
Rows
Done
N/A
Not valid
01 Check foam applicator couplings and hose couplings
02 Check foam applicator water hoses and foam hoses
03 Verify all portable foam applicators are set to the correct proportioning
04 Verify all portable containers or portable tanks containing foam concentrate remain factory sealed, and the manufacturer's recommended service life interval has not been exceeded
05 Portable containers or portable tanks containing foam concentrate, excluding protein-based concentrates, less than 10 years old, that remain factory sealed can normally be accepted without the periodical foam control tests required in MSC.1/Circ.1312 being carried out;
06 Protein based foam concentrate portable containers and portable tanks should be thoroughly checked and, if more than five years old, the foam concentrate should be subjected to the periodical foam control tests required in MSC.1/Circ.1312, or renewed
07 Foam concentrates of any non-sealed portable containers and portable tanks, where production data is not documented, should be subjected to the periodical foam control tests required in MSC.1/Circ.1312.
Woell Marine Stamp & Signature
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Cusomer Name
First Name
Last Name
Customer E-Mail
example@example.com
Technician Name
First Name
Last Name
Technician Email
example@example.com
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