UO Submission Form

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LUKOIL Marine Lubricants

Please fill in the sampling form thoroughly and legibly. To enable us to provide the best
possible service to our customers fill all the boxes. – Mandatory boxes are marked in red!

Vessel Name IMO Number

Owner/Manager Name VAT Number

Machinery / Unit # Maker


(e.g. Maine Engine / Cyl.1) (e.g. MAN)
Model/Type and Version Serial No.
(e.g. 9G80ME-C9.2)
Sampled by Sample Date
(Ranking) (Day/Month/Year)
Place Sample taken/Port landed Unit Running Hours
[R/Hrs]

Recommended Used Oil Grade


LUKOIL Grade
Daily Make up Oil Capacity Hrs since Hrs since
[Ltrs] [Ltrs] last Oil change Filter change
Special / Other
Routine sample of oil in use

Fuel in Use Fuel Sulfur


2 Stroke Engine (e.g. RMF180) Content [%wt]

4 Stroke Engine Bunker Port


!!! Please attach relevant copy of Bunker Analysis Report.

Hydraulic Gearbox Stern Tube Shaft Bearing

Compressor Operating Gas


(e.g. R22, R407C, etc.)

Cylinder Scrapedown Analysis ONLY *** The below data shall be taken at the same time of CSA sampling.

Cyl. Lubricator MCL Consumption Actual Feedrate


Type by measuring tank [l/d] [g/kW/h]
(e.g. Alpha Mk1 or Mk2, Pulse, CLU3, HJ Mechanical, Lubtronic, SIP II, etc.)
Engine Power Liner Ambient Temp.
MCR [kW] Running Hours [°C]

Engine Load Piston Crown Ambient


[%] Running Hours Humidity [%]

Engine RPM Piston Ring Scavenge Air


Running Hours Temp. [°C]

Abs. Scavenge Fuel Valve Water from


Air Press. Running Hours Scavenger [t/d]

Remark

Rev.1 on 01.10.2014.

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