| For Ship | For Barge |
|
Name ___________________________
Rank ____________________________
Signature _________________________
Date _____________________________
Time _____________________________
|
Name ___________________________
Rank ____________________________
Signature _________________________
Date _____________________________
Time _____________________________
|
Record of repetitive checks:
| Date :
|
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| Time :
|
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| Initials for Ship :
|
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|
Initials for Barge :
|

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