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pdfAnnual Ballast Water Summary Report
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National Ballast Information Clearinghouse
*** DRAFT *** DRAFT *** DRAFT *** DRAFT *** DRAFT *** DRAFT *** DRAFT ***
OMB Control Number 1625-0069
Exp. Date: 08/31/2018
Annual Ballast Water Summary Report for 2015 (see 33 CFR §151.2060)
(For vessels operating exclusively between ports in a single Captain of the Port Zone)
1. Vessel Information
Vessel name:
Vessel IMO number:
Fill in vessel information from IMO number
Call sign:
Vessel owner/operator:
Vessel type:
Select vessel type
Vessel tonnage (GT):
Total ballast water capacity:
meters^3
Number of ballast tanks on ship:
Ballast water treatment system:
2. Operational Information
COTP Zone of operation:
Select Zone
Primary port of ballast water loading:
Primary port of ballast water discharge:
Estimated times ballast water was discharged:
Estimated volume of each ballast discharge:
3. Certification
Vessel complies with the requirements
of 33 CFR §151.2050:
meters^3
Agreed
Authorized representative (name and title):
Contact information:
Submit report
Questions or comments? Please contact us: nbic@ballastreport.org
http://si-pweb11.si.edu/cgi/annual
09/09/2015
File Type | application/pdf |
File Title | http://si-pweb11.si.edu/cgi/annual |
Author | DADuPont |
File Modified | 2015-09-11 |
File Created | 2015-09-09 |