FORM S/3
Clasification Society 2024 - Version 9.40
Statutory Documents - IMO Publications and Documents - Resolutions - Marine Environment Protection Committee - Resolution MEPC.357(78) - 2022 Guidelines for Inspection of Anti-Fouling Systems on Ships - (adopted on 10 June 2022) - Annex - 2022 Guidelines for Inspection of Anti-Fouling Systems on Ships - Appendix 1 - Sampling - FORM S/3

FORM S/3

         
  RECORD NUMBER      
 

Name of ship

_________________________

IMO number:

_________________________

METHOD 1 ANALYSIS

Case A - Analysis of organotin only
1. Instrument I.D.:   Calibration expire date:  
2. Specimens 'A' results Total number of specimens 'A' analysed:  
3. No. Sample location (frame & distance from boot topping) mg Sn/kg No. Sample location(frame & distance from boot topping) mg Sn/kg
  1     9    
  2     10    
  3     11    
  4     12    
  5     13    
  6     14    
  7     15    
  8     16    
4. Results            
    Number of specimens exceeding 2,500 mg/kg:

☐ Step 2 required
    1 or more specimens exceeding 3,000 mg/kg    
    ☐ Yes ☐ No   ☐ Compliance,no further analysis
5. Additional comments concerning analysis of results from Specimens 'A'
6. Company Name:

Date:

Signature:
7. Instrument I.D.:   Calibration expire date:  
8. Specimens 'B' results Total number of specimens "B" analysed:  
9. No. organotin (mg Sn/kg) as Sn No. organotin (mg Sn/kg) as Sn No. organotin (mg Sn/kg) as Sn No. organotin (mg Sn/kg) as Sn
  1   5   9   13  
  2   6   10   14  
  3   7   11   15  
  4   8   12   16  
10. Results            
    Number of specimens exceeding 2,500 mg/kg:

☐ Non-compliance assumed
    1 or more specimens exceeding 3,000 mg/kg    
    ☐ Yes ☐ No   ☐ Compliance assumed
11. Additional comments concerning analysis of results from Specimens 'B'
12. Company Name:

Date:

Signature:

Case B - Analysis of cybutryne only

Gas chromatography/mass spectrophotometry (GC/MS) analysis
1. Instrument I.D.:   Calibration expire date:  
2. Specimens 'C' results
  Total number of specimens 'C' analysed by GC-MS:  
  Average concentration of cybutryne (mg of cybutryne per kg of dry paint):  
3. Conclusions

The average concentration of cybutryne exceeds the threshold of 1,250 mg of cybutryne per kg of dry paint

☐ Yes

☐ No. Compliance assumed.

4. Additional comments concerning analysis of results from Specimens 'C'
5. Company Name:

Date:

Signature:

Case C - Simplified approach to detect organotin and cybutryne

Gas chromatography/mass spectrophotometry (GC/MS) analysis
1. Instrument I.D.:   Calibration expire date:  
2. Specimens 'C' results
  Total number of specimens 'C' analysed by GC-MS:  
  Average concentration of organotin (mg Sn/kg of dry paint)  
  Average concentration of cybutryne (mg of cybutryne per kg of dry paint):  
3. Conclusions
  The average concentration of organotin exceeds the threshold of 3,000 mg Sn per kg of dry paint ☐ Yes

☐ No. Compliance assumed.
  The average concentration of cybutryne exceeds the threshold of 1,250 mg of cybutryne per kg of dry paint ☐ Yes

☐ No. Compliance assumed.
4. Additional comments concerning analysis of results from Specimens 'C'
5. Company Name:

Date:

Signature:
Parent topic: Appendix 1 - Sampling
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