Bin Monitoring Inspection Request Form

Revised: 08/22/07

OMB Control No. 0648-xxxx, Expiration Date: xx/xx/xxxx

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

BIN MONITORING
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

Today’s Date

Telephone Number for Contact Person

Location of vessel, including street address and city

Fax Number
Requesting Person’s Signature

1. Have you received and passed a prior bin monitoring inspection?

□ YES

□ NO

2. If YES, what is the date of the most recent inspection? _____________________________
Note: 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.
Select Option:
□ No crew in bin

□ Line of Sight

□ Video

Attachment:
Include a diagram drawn to scale showing the locations where all catch will be weighed and sorted by the
observer, the location where unsorted catch will be collected, and the location of any video equipment or
viewing panels or ports.
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 NOAA, National Marine Fisheries Service, Alaska Region, Attn: Assistant Regional Administrator, Sustainable Fisheries
Division, 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 being used 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 in 2006; 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.