I, __________, the person in charge of the transfer of liquid cargo in bulk about to begin, do certify that I have personally inspected this vessel with reference to the following requirements set forth in 46 CFR 35.35-20, and that opposite each of the applicable items listed below I have indicated whether the vessel complies with all pertinent regulations.

(1) Are warnings displayed as required?

(2) Is there any repair work in way of cargo spaces being carried on for which permission has not been given?

(3) Have cargo connections been made as described in 46 CFR 35.35-15 and are cargo valves set?

(4) Have all cargo connections been made to the vessel's pipeline and not through an open-end hose led through a hatch?

(5) Are there any fires or open flames present on the deck or in any compartment which is located on, open or adjacent to or facing the main deck of the vessels on which the cargo connections have been made?

(6) Has the shore terminal or other tank vessel concerned reported itself in readiness for transfer of cargo?

(7) Are sea valves connected to the cargo piping system closed?

(8) If Grades, A, B, or C cargoes are to be loaded and boiler fires are lighted, has an inspection been made to determine whether these fires may be maintained with reasonable safety?

(9) If Grades A, B, or C cargoes are to be loaded and galley fires are lighted, has an inspection been made to determine whether the galley fires may be maintained with reasonable safety?

(10) If Grades A, B, or C cargoes are to be loaded, has an inspection been made to determine whether smoking is to be permitted in areas not on the weather decks?

(11) If smoking is to be permitted in areas not on the weather decks, have those areas been designated?

(12) Is the inert gas system being operated as necessary to maintain an inert atmosphere in the cargo tanks in compliance with 46 CFR 32.53-5?

(13) Have the applicable sections of the vessel response plan been reviewed before commencing transfer, and arrangements or contingencies made for implementation of the Plan should the need arise?

(1) Is each part of the vapor collection system aligned to allow vapor to flow to or from the facility vapor connection or, if lightering, to the other vessel?

(2) Are the vapor collection hoses or arms connected to the vessel's vapor collection connection?

(3) Are the vessel and facility vapor connections electrically isolated?

(4) Have the initial transfer rate and the maximum transfer rate been determined?

(5) Have the maximum and minimum operating pressures at the facility vapor connection, or the vessel vapor connection if lightering, been determined?

(6) Have all alarms required by §§ 39.20-7, 39.20-9 and 39.40-3(a) of this subchapter been tested within 24 hours prior to the start of the transfer operation and found to be operating properly?

(7) Is each vapor recovery hose free of unrepaired loose covers, kinks, bulges, soft spots, or any other defect which would permit the discharge of vapors through the hose material, and gouges, cuts, or slashes that penetrate the first layer of hose reinforcement?

(8) Has the oxygen content in the vapor space of each of the vessel's inerted cargo tanks connected to the vapor collection system been verified to be—

(i) At or below 60 percent by volume, at the start of cargo transfer, of the cargo's minimum oxygen concentration for combustion; or

(ii) At or below 8 percent by volume, at the start of cargo transfer, for vapor of crude oil, gasoline blends, or benzene.