LIETUVOS RESPUBLIKOS APLINKOS MINISTRO LIETUVOS RESPUBLIKOS APLINKOS MINISTRO ĮSAKYMAS DĖL LAIVO PATIKRINIMO AKTO, SPRENDIMO SULAIKYTI LAIVĄ IR NUTARIMO PANAIKINTI SPRENDIMĄ SULAIKYTI LAIVĄ FORMŲ TVIRTINIMO 2008 m. kovo 13 d. Nr. D1-137 Vilnius Vadovaudamasis Lietuvos Respublikos Vyriausybės 2008 m. vasario 6 d. nutarimu Nr. 95 „Dėl įgaliojimų suteikimo įgyvendinant Lietuvos Respublikos aplinkos apsaugos valstybinės kontrolės įstatymo 394, 395 ir 396 straipsnius“ (Žin., 2008, Nr. 19-686), tvirtinu pridedamas:
- Laivo patikrinimo akto formą.
- Sprendimo sulaikyti laivą formą.
- Nutarimo panaikinti sprendimą sulaikyti laivą formą. Aplinkos ministras Artūras Paulauskas Forma patvirtinta Lietuvos Respublikos aplinkos ministro 2008 m. kovo 13 d. Nr. D1-137 LIETUVOS RESPUBLIKOS APLINKOS MINISTERIJOS KLAIPĖDOS REGIONO APLINKOS APSAUGOS DEPARTAMENTAS KLAIPEDA REGIONAL ENVIRONMENTAL PROTECTION DEPARTMENT OF MINISTRY OF ENVIRONMENT OF THE REPUBLIC OF LITHUANIA LAIVO PATIKRINIMO AKTAS SHIP INSPECTION ACT 20___-_____-_____ Nr. (metai, mėnuo, diena) (year, month, day) ________________________________ (surašymo vieta) (place of census) Aš /I,______________________________________________________________________ (aplinkos apsaugos valstybinės kontrolės pareigūno (toliau – Pareigūnas) tarnybos vieta) (service place of state environmental protection control officer (hereinafter referred to as the „Officer“)) ___________________________________________________________________________ _______________________ valstybinis aplinkos apsaugos inspektorius / state environmental protection inspector,__________________________________________________________ (Pareigūno vardas, pavardė) (Officer’s name, surname) dalyvaujant / also participating__________________________________________________ ___________________________________________________________________________ (kitų dalyvavusių Pareigūnų pareigos, vardai, pavardės, liudytojų vardai, pavardės, adresai, telefonai, (names, surnames, position of other participating Officers, names, surnames, addresses, telephones of witnesses, ___________________________________________________________________________ kitų institucijų atstovų pareigos, vardai, pavardės) names, surnames, positions of representatives of other institutions) ___________________________________________________________________________ ___________________________________________________________________________ bei laivo kapitonui (laivo kapitono paskirtam įgulos nariui) / and ship’s captain (crew member (kas nereikalinga, išbraukti) (delete unnecessary) appointed by ship’s captain)____________________________________________________ (pareigos (nurodomos, jeigu laivo kapitono paskirtas įgulos narys), vardas, pavardė) (position (indicate if it is crew member appointed by ship’s captain), name, surname) ___________________________________________________________________________ patikrinau laivą / have inspected the ship__________________________________________ ___________________________________________________________________________ (laivo pavadinimas, laivo TJO numeris, valstybė, su kurios vėliava plaukioja laivas, laivo tipas, laivo bendras tonažas, (name of ship, ship’s IMO number, flag state, type of ship, gross tonnage of ship, upbuilding year of ship, as indicated ___________________________________________________________________________ laivo pastatymo metai, kaip nurodyta laivo liudijimuose, laivo savininko (valdytojo) ar laivo frachtuotojo pavadinimas, in ship’s certificates, name of ship’s owner (possessor) or ship’s charterer, legal form, head office, code, name, ___________________________________________________________________________ teisinė forma, buveinė, kodas, vardas, pavardė, gyvenamoji vieta, asmens kodas) surname, place of residence, personal identification number) ___________________________________________________________________________ ___________________________________________________________________________ Laivo patikrinimo priežastys / Reasons of ship’s inspection:___________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Patikrinimas pradėtas / Inspection was initiated at _________ val. / h. _______ min., baigtas / and it was finished at _________ val. / h. _______ min. Patikrinimo objektas ir eiga, naudotos patikrinimo priemonės / Inspection object and process, used inspection measures:___________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Laivo patikrinimo metu nustatyta / It was determined during ship’s inspection:____________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Tikrinamo laivo kapitono ar jo paskirto įgulos nario paaiškinimai, prašymai, skundai, susiję su laivo patikrinimu / Explanations, applications, claims of inspected ship’s captain or his appointed crew member, associated with ship’s inspection:____________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Tikrino / Inspector: ___________________________ ___________ ________________________ (Pareigūno pareigų pavadinimas) (parašas) (vardas, pavardė) (Officer’s position) (signature) (name, surname) Dalyvavo / Participants: ___________________________ ___________ ________________________ (pareigų pavadinimas) (parašas) (vardas, pavardė) (position) (signature) (name, surname) ___________________________ ___________ ________________________ ___________________________ ___________ ________________________ ___________________________ ___________ ________________________ ___________________________ ___________ ________________________ ___________________________ ___________ ________________________ ___________________________ ___________ ________________________ ___________________________ ___________ ________________________ Laivo patikrinimo aktas surašytas 2 egzemplioriais / Ship’s inspection act is made in 2 copies. Su laivo patikrinimo aktu susipažinau ir laivo patikrinimo akto antrą egzempliorių gavau / I am acquainted with ship’s inspection act and I have received the second copy of ship’s inspection act: ___________________ (pareigos) (position) ___________________ (parašas) (signature) ___________________ (vardas, pavardė) (name, surname) ___________________ (data) (date) _________________ Forma patvirtinta Lietuvos Respublikos aplinkos ministro 2008 m. kovo 13 d. Nr. D1-137 LIETUVOS RESPUBLIKOS APLINKOS MINISTERIJOS KLAIPĖDOS REGIONO APLINKOS APSAUGOS DEPARTAMENTAS KLAIPEDA REGIONAL ENVIRONMENTAL PROTECTION DEPARTMENT OF MINISTRY OF ENVIRONMENT OF THE REPUBLIC OF LITHUANIA NUTARIMAS PANAIKINTI SPRENDIMĄ SULAIKYTI LAIVĄ RESOLUTION TO REVOKE THE DECISION TO DETAIN A SHIP 20___-_____-_____ Nr. (metai, mėnuo, diena) (year, month, day) __________________________________ (surašymo vieta) (place of census) Aš / I,______________________________________________________________________ (aplinkos apsaugos valstybinės kontrolės pareigūno (toliau – Pareigūnas) tarnybos vieta) (service place of state environmental protection control officer (hereinafter referred to as the „Officer“)) ___________________________________________________________________________ _______________________ valstybinis aplinkos apsaugos inspektorius / state environmental protection inspector,__________________________________________________________ (Pareigūno vardas, pavardė) (Officer’s name, surname) Atsižvelgdamas į tai, kad / In respect that_________________________________________ ___________________________________________________________________________ (aplinkybės, kurių pagrindu panaikinamas sprendimas sulaikyti laivą) (circumstances, on the ground of which the decision to detain a ship is revocable) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ bei vadovaudamasis Lietuvos Respublikos aplinkos apsaugos valstybinės kontrolės įstatymo 396 str. 1 d. _____ p., priėmiau nutarimą panaikinti sprendimą sulaikyti laivą / and following point _____ of part 1 of article 396 of environmental protection state control law of the Republic of Lithuania, I have adopted a resolution to revoke the decision to detain a ship_____________________________________________ ___________________________________________________________________________ (laivo pavadinimas, laivo TJO numeris, valstybė, su kurios vėliava plaukioja laivas, laivo tipas, laivo bendras tonažas, (name of ship, ship’s IMO number, flag state, type of ship, gross tonnage of ship, upbuilding year of ship, as indicated in ___________________________________________________________________________ laivo pastatymo metai, kaip nurodyta laivo liudijimuose, laivo savininko (valdytojo) ar laivo frachtuotojo pavadinimas, ship’s certificates, name of ship’s owner (possessor) or ship’s charterer, legal form, head office, code, name, surname, ___________________________________________________________________________ teisinė forma, buveinė, kodas, vardas, pavardė, gyvenamoji vieta, asmens kodas) place of residence, personal identification number) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________ ___________ ________________________ (Pareigūno pareigų pavadinimas) (parašas) (vardas, pavardė) (Officer’s position) (signature) (name, surname) _________________ Forma patvirtinta Lietuvos Respublikos aplinkos ministro 2008 m. kovo 13 d. Nr. D1-137 LIETUVOS RESPUBLIKOS APLINKOS MINISTERIJOS KLAIPĖDOS REGIONO APLINKOS APSAUGOS DEPARTAMENTAS KLAIPEDA REGIONAL ENVIRONMENTAL PROTECTION DEPARTMENT OF MINISTRY OF ENVIRONMENT OF THE REPUBLIC OF LITHUANIA SPRENDIMAS SULAIKYTI LAIVĄ DECISION TO DETAIN A SHIP 20___-_____-_____ Nr. (metai, mėnuo, diena) (year, month, day) ____________________________ (surašymo vieta) (place of census) Aš /I,______________________________________________________________________ (aplinkos apsaugos valstybinės kontrolės pareigūno (toliau – Pareigūnas) tarnybos vieta) (service place of state environmental protection control officer (hereinafter referred to as the „Officer“)) ___________________________________________________________________________ _______________________ valstybinis aplinkos apsaugos inspektorius / state environmental protection inspector,__________________________________________________________ (Pareigūno vardas, pavardė) (Officer’s name, surname) nustačiau, kad / have determined, that____________________________________________ ___________________________________________________________________________ (duomenys, leidžiantys manyti, kad laivas įvykdė pažeidimą) (data, allowable to suppose that ship has committed an offence) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ todėl, vadovaudamasis Lietuvos Respublikos aplinkos apsaugos valstybinės kontrolės įstatymo 395 str. 1 d., priėmiau sprendimą sulaikyti laivą / therefore, following part 1 of article 395 of environmental protection state control law of the Republic of Lithuania, I have decided to detain a ship___________ ___________________________________________________________________________ (laivo pavadinimas, laivo TJO numeris, valstybė, su kurios vėliava plaukioja laivas, laivo tipas, laivo bendras tonažas, (name of ship, ship’s IMO number, flag state, type of ship, gross tonnage of ship, upbuilding year of ship, as indicated in ___________________________________________________________________________ laivo pastatymo metai, kaip nurodyta laivo liudijimuose, laivo savininko (valdytojo) ar laivo frachtuotojo pavadinimas, ship’s certificates, name of ship’s owner (possessor) or ship’s charterer, legal form, head office, code, name, surname, ___________________________________________________________________________ teisinė forma, buveinė, kodas, vardas, pavardė, gyvenamoji vieta, asmens kodas) place of residence, personal identification number) ___________________________________________________________________________ ___________________________________________________________________________ Sprendimas sulaikyti laivą per 10 d. nuo jo priėmimo dienos gali būti apskundžiamas rajono (miesto) apylinkės teismui / The decision to detain a ship may be appealed to region (city) district court within 10 days from the day of its acceptance. ___________________________ ___________ ________________________ (Pareigūno pareigų pavadinimas) (parašas) (vardas, pavardė) (Officer’s position) (signature) (name, surname) Sprendimas sulaikyti laivą surašytas 3 egzemplioriais / The decision to detain a ship is made in 3 copies. Su sprendimu sulaikyti laivą susipažinau ir sprendimo sulaikyti laivą antrą egzempliorių gavau /I am acquainted with the decision to detain a ship and I have received the second copy of the decision to detain a ship: ___________________ (pareigos) (position) ___________________ (parašas) (signature) ___________________ (vardas, pavardė) (name, surname) ___________________ (data) (date) _________________