CG-6047 International Sewage Pollution Prevention Equivalency Ce

OMB APPROVAL 1625-0041

INTERNATIONAL SEWAGE POLLUTION PREVENTION
EQUIVALENCY CERTIFICATE
The United States Coast Guard has determined that compliance with
33 CFR Part 159
is equivalent to compliance with MARPOL 73/78 Annex IV (Revised)
Issued under the provisions of
33 CODE OF FEDERAL REGULATIONS PART 159
under the authority of the Government of

THE UNITED STATES OF AMERICA
By the UNITED STATES COAST GUARD

THIS IS TO CERTIFY:
1. That the below mentioned ship is equipped with a sewage treatment system
in compliance with the applicable provisions of 33 CFR Part 159; and
2. That the survey showed that the equipment on board is in all respects
satisfactory and that the vessel complies with the relevant provisions of the
Code of Federal Regulations and is equivalent to compliance with MARPOL
73/78 Annex IV (Revised).
Particulars of ship:
Name of ship
Distinctive number or letters
Port of registry
Gross tonnage
Number of persons which the ship is certified to carry
IMO number
This Certificate is valid until
Issued at

Date of Issue

Officer in Charge, Marine Inspection, U. S. Coast Guard

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 10 minutes.
You may submit comments concerning the accuracy of this burden estimate or any suggestions for reducing the burden to
COMDT (G-MOC), U.S. Coast Guard, Washington, DC 20593-0001 or Office of Management and Budget, Paperwork
Reduction Project (1625-0041), Washington, DC 20503.
U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-6047 Rev. (06-04)

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Vessel Name:

Date Issued

INTERNATIONAL SEWAGE POLLUTION PREVENTION EQUIVALENCY

ENDORSEMENT FOR ANNUAL AND INTERMEDIATE SURVEYS
THIS IS TO CERTIFY that a survey determined that the vessel equivalently complies with the
relevant provisions of 33 CFR Part 159:

Annual Survey:

Signed:
Place:
Date:

Annual*/Intermediate Survey:

Signed:
Place:
Date:

Annual*/Intermediate Survey:

Signed:
Place:
Date:

Annual Survey:

Signed:
Place:
Date:

* Delete as Appropriate

U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-6047 Rev. (06-04)

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