CG-854 Temporary Certificate of Inspection

OMB Approved No. 1625-0057

UNITED STATES OF AMERICA
U.S. DEPARTMENT OF HOMELAND SECURITY

UNITED STATES COAST GUARD

TEMPORARY CERTIFICATE OF INSPECTION
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 5 mins. You may submit any comments concerning the accuracy of this burden estimate or
any suggestion reducing the burden to: Commandant (G-MOC), U.S. Coast Guard, Washington, DC 20593-0001 or Office of Management and Budget, Paperwork
Reduction Project (1625-0057), Washington, DC 20503,.

This Temporary Certificate of Inspection is issued under the provisions of Title 46 United States Code,
Section 399, in lieu of the regular certificate of inspection, and shall be in force only until the receipt on board said
vessel of the original certificate of inspection, this certificate in no case to be valid after one year from the date of
inspection.
VESSEL

OFFICIAL NUMBER

CLASS

GROSS TONS

HOME PORT

OWNER/ADDRESS

OPERATOR/ADDRESS

The following complement of licensed officers and crew is required to be carried; included in which there
Certificated Lifeboatment and
Certificated Tankermen:
must be
Master

Master &
1st Class Pilot

Able Seamen

Chief Engineer

Fireman/
Watertenders

Chief Mate

Class Pilot

Ordinary Seamen

1st Asst. Engineer

Oilers

2nd Mate

Radio Officer

Deckhands

2nd Asst. Engineer

Mate(s)

Operator(s)

In addition the vessel may carry
persons in addition to the crew, and
Maximum steam pressure allowed

Engineer(s)

other persons in the crew,
passengers,
. Total persons allowed

.

DATE DRYDOCKED

p.s.i.

ROUTE PERMITTED AND CONDITIONS OF OPERATION

INSPECTED AND APPROVED FOR THE CARRIAGE OF

Inspection of the above vessel was completed on
I HEREBY CERTIFY that on this
date the vessel was in all respects in conformity with applicable vessel inspection laws and regulations prescribed
thereunder.
OFFICER IN CHARGE, MARINE INSPECTION
U.S. DEPT. OF HOMELAND SECURITY, USCG - CG-854 (Rev. 06-04)
PREVIOUS EDITIONS ARE OBSOLETE

INSPECTION ZONE

Original

OMB Approved No. 1625-0057

UNITED STATES OF AMERICA
U.S. DEPARTMENT OF HOMELAND SECURITY

UNITED STATES COAST GUARD

TEMPORARY CERTIFICATE OF INSPECTION
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 5 mins. You may submit any comments concerning the accuracy of this burden estimate or
any suggestion reducing the burden to: Commandant (G-MOC ), U.S. Coast Guard, Washington, DC 20593-0001 or Office of management and Budget, Paperwork
Reduction Project (1625-0057), Washington, DC 20503,.

This Temporary Certificate of Inspection is issued under the provisions of Title 46 United States Code,
Section 399, in lieu of the regular certificate of inspection, and shall be in force only until the receipt on board said
vessel of the original certificate of inspection, this certificate in no case to be valid after one year from the date of
inspection.
VESSEL

OFFICIAL NUMBER

CLASS

GROSS TONS

HOME PORT

OWNER/ADDRESS

OPERATOR/ADDRESS

The following complement of licensed officers and crew is required to be carried; included in which there
Certificated Lifeboatment and
Certificated Tankermen:
must be
Master

Master &
1st Class Pilot

Able Seamen

Chief Engineer

Fireman/
Watertenders

Chief Mate

Class Pilot

Ordinary Seamen

1st Asst. Engineer

Oilers

2nd Mate

Radio Officer

Deckhands

2nd Asst. Engineer

Mate(s)

Operator(s)

In addition the vessel may carry
persons in addition to the crew, and
Maximum steam pressure allowed

Engineer(s)

other persons in the crew,
passengers,
. Total persons allowed

.

DATE DRYDOCKED

p.s.i.

ROUTE PERMITTED AND CONDITIONS OF OPERATION

INSPECTED AND APPROVED FOR THE CARRIAGE OF

Inspection of the above vessel was completed on
I HEREBY CERTIFY that on this
date the vessel was in all respects in conformity with applicable vessel inspection laws and regulations prescribed
thereunder.
OFFICER IN CHARGE, MARINE INSPECTION
U.S. DEPT. OF HOMELAND SECURITY, USCG - CG-854 (Rev. 06-04)
PREVIOUS EDITIONS ARE OBSOLETE

INSPECTION ZONE

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