International Dolphin Conservation Program Vessel Operat

OMB Control No. 0648-0387
Expires: June 30, 2018

OPERATOR PERMIT APPLICATION - 2016
No Fee Required
The collection of information is mandated by the Marine Mammal Protection Act (16 U.S.C. 1371) and by implementing regulations contained at 50 CFR §216.24(b)(2). The
information supplied on this form will be used by the National Marine Fisheries Service to authorize the incidental take and to alert vessel owners of applicable rules and
regulations regarding the permit for the taking of marine mammals incidental to commercial purse seine fishing for yellowfin tuna in the eastern tropical Pacific Ocean. The
name of the operator supplied on this form may be released under the Freedom of Information Act. All other information supplied on this form are considered proprietary and
therefore subject to data confidentiality restriction of National Oceanic and Atmospheric Administration Administrative Order 216-100.

1. OPERATOR INFORMATION
OPERATOR NAME:
(First, Middle, Last)

HOME ADDRESS:
TELEPHONE:
FAX:
EMAIL:
2. PERMIT INFORMATION
VESSEL NAME(S):

DATE, LOCATION, AND PROVIDER OF MOST RECENT TUNA PURSE SEINE MARINE MAMMAL SKIPPER WORKSHOP:

OTHER FEDERAL, STATE, AND COMMERCIAL LICENSES HELD BY OPERATOR:
(include type, identification numbers, and expiration dates)

I declare that the information in this application is true and complete.

APPLICANT'S SIGNATURE

__________________________
DATE

-or_____________________________ __________________________________________
APPLICANT'S REPRESENTATIVE NAME (PLEASE PRINT)
SIGNATURE
DATE
Upon Completion, submit to: National Marine Fisheries Service, Attn: Permits, 501 West Ocean Blvd., Suite 4200, Long Beach CA 908024213
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to Regional Administrator, West Coast Region, National Marine Fisheries Service, 501
West Ocean Boulevard, Suite 4200, Long Beach, California, 90802-4213, (562) 980-4000
The National Marine Fisheries Service may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current and valid
OMB Control number.