Observer Sampling Station Inspection Request Form

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    	   Revised: 04/19//2012         						                       OMB Control No. 0648-0330, Expiration Date:  01/31/2014  
ELECTRONIC MONITORING SYSTEM
 INSPECTION REQUEST FORM
Fax, mail, or e-mail completed forms and diagrams to:

North Pacific Groundfish Observer Program
7600 Sand Point Way NE, Bldg 4
Seattle, WA 98115
Ph: 206-526-4007
Fax: 206-526-4066
e-mail: [email protected]
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.

DIAGRAM ATTACHMENT
You must attach with this request a diagram drawn to scale showing:
	♦	All locations where salmon will be sorted
	♦	Location of the salmon storage container
	♦	Location of each camera and its coverage area
	♦	Location of any additional video equipment, including monitors and hard drives
BLOCK A – VESSEL INFORMATION
Name of Vessel
Federal Fishery Permit No.
Name
 Requesting Person’s Signature
Date
Business Mailing Address


Business Telephone No.
Business Fax No.
Business e-mail Address
The individual or company responsible for installing and maintaining the system

The individual onboard the vessel responsible for maintaining the system and assisting observer in its use
BLOCK B – SYSTEM SPECIFICATIONS
Pixel length & width of image
File type in which data are recorded
Compression Type
Frame rate at which data are recorded
Storage device type and size
Brand and model number of the cameras
Brand, model, and specifications of the lenses
The type, speed, and operating system of any computer that is part of the system

Any change to the electronic monitoring system that would affect the system's functionality must be submitted to, and
approved by, the Regional Administrator in writing before that change is made. 

Inspections will be conducted on vessels tied to docks at Dutch Harbor, Alaska; Kodiak, Alaska; and in the Puget Sound area of Washington State. 

An electronic monitoring system inspection report, valid for 12 months from the date it is issued by NMFS, will be issued to the vessel owner if the electronic monitoring system meets the requirements.  The vessel owner must maintain a current electronic monitoring system inspection report onboard the vessel at all times the vessel is required to provide an approved electronic monitoring system. The electronic monitoring system inspection report must be made available to the observer, NMFS personnel, or to an authorized officer upon request.

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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 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 Chinook PSC 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 electronic monitoring systems; 5) Responses to this information request are not confidential
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