Observer Sampling Station Inspection Request Form

Revised 4/23/07

OMB Control No. 0648-0330, Expiration Date: 2/28/2009

Fax, mail, or e-mail completed forms and diagrams to:

OBSERVER
SAMPLING STATION
INSPECTION REQUEST FORM

Jason Stern
North Pacific Groundfish Observer Program
7600 Sand Point Way NE, Bldg 4
Seattle, WA 98115
Ph: 206-526-4518
Fax: 206-526-4066
e-mail: [email protected]

Vessel Name
Federal Fishery Permit Number

Requested Inspection Date

Business Mailing Address

Contact Person On Vessel

Fax Number

Telephone Number for Contact Person

Location of vessel, including street address and city

Today’s Date
Requesting Person’s Signature

1. For scale inspections, please contact Alan Kinsolving at 928-774-4362 for scheduling.
2. Have you received and passed a scale inspection?
□ YES
□ NO
3. If YES, what is the date of the most recent inspection? _____________________________
Inspections will be scheduled within ten (10) working days of receiving a request. Requests for inspections in Dutch
Harbor and Kodiak will be scheduled within ten (10) days, but may be delayed several days due to weather or logistics.
OBSERVER SAMPLING STATION

Attachment
For catcher/processors using trawl gear and motherships, include a diagram drawn to scale showing the
location(s) where all catch will be weighed, the location where observers will sample unsorted catch, and the
location of the observer sampling station, including the observer sampling scale, and the name of the manufacturer
and model of the observer sampling scale.
For all other vessels, include a diagram drawn to scale showing the location(s) where catch comes on board the
vessel, the location where observers will sample unsorted catch, the location of the observer sampling station,
including the observer sampling scale, and the name of the manufacturer and model of the observer sampling scale.

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PUBLIC REPORTING BURDEN STATEMENT
Public reporting burden for this collection of information is estimated to average 2 hours per response, including the
time for reviewing the 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 the burden, to Assistant Regional
Administrator, Sustainable Fisheries Division, NOAA, National Marine Fisheries Service, Alaska Region ,P.O. Box
21668, Juneau, AK 99802-1668 (Attn: Records Officer).
ADDITIONAL INFORMATION
Before completing this form please note the following: 1) Notwithstanding any other provision of law, no person is
required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of
information subject to the requirements of the Paperwork Reduction Act, unless that collection of information
displays a currently valid OMB Control Number; 2) This information is mandatory and is required to manage the
At-Sea Scales Program and commercial fishing efforts under 50 CFR part 679 and under section 402(a) of the
Magnuson-Stevens Act (16 U.S.C. 1801, et seq.) as amended by Public Law 109-479; 4) Submission of this
information is necessary for NMFS to approve scales to weigh catch at sea; 5) Responses to this information request
are not confidential.
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