Inspection request for observer sampling station

Revised: 10/30/2014 OMB Control No. 0648-0330, Expiration Date: 11/30/2015

INSPECTION REQUEST FORM (OBSERVER SAMPLE STATION, VIDEO, BIN MONITORING and AT-SEA SCALES)

At-sea Scales, BSAI Longline C/Ps Video, and Flow Scale: Fax, mail, or email completed forms and diagrams to: U.S. Department of Commerce NOAA/NMFS, Alaska Region PO Box 21668 Juneau, AK 99802-1668 Ph: 907-586-7228 Fax: 907-586-7465 Email:[email protected]

Bin Monitoring, Chinook Salmon Bycatch Monitoring, and Observer Sample Station: Fax, mail, or e-mail completed forms and diagrams to: FMA Observer Program 7600 Sand Point Way NE, Bldg 4 Seattle, WA 98115 Ph: 206-526-4007 Fax: 206-526-4066 Email: [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.

VESSEL INFORMATION
Vessel Name:		Federal Fisheries Permit:							Vessel Contact Name:
Vessel Contact Phone:				Vessel Contact E-mail:
Address of Vessel Location for Inspection:						Phone/Email on Vessel:
VIDEO SYSTEM SELECTION
Select Video Monitoring Systems To Be Inspected:(more than one may be selected) □ Video Bin Monitoring Option □ Chinook Salmon Bycatch □ BSAI Longline C/Ps □ Flow Scale
Name of Video Installer to install & maintain system:					Person on vessel to maintain system & aid observer:
Will video installer be on site at inspection? □ Yes □ No				Requested Inspection Date & Time:
VIDEO 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 & size
Brand & model number of the cameras				Brand, model, & specifications of the lenses
Type, speed, & operating system of computer that is part of the system
VIDEO MONITORING DIAGRAM ATTACHMENT
You must attach a diagram that is clearly labeled and drawn to scale showing: Location of each camera & its coverage area Location of any additional video equipment, including monitors & hard drives All locations where sorting occurs Location of motion-compensated flow scale Chinook Salmon Bycatch Monitoring: Location of salmon storage container
OBSERVER SAMPLING STATION
Observer Sampling Station and At-Sea Scale Inspections should be scheduled at least one hour apart.
Would you like your observer sampling station inspection on a different date and time than the video inspection? □ Yes □ No							If YES, what date and time?
Diagram for trawl C/Ps & motherships, clearly labeled and 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 table. Diagram for all other vessels, 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 table.
AT-SEA SCALES
Observer Sampling Station and At-Sea Scale Inspections should be scheduled at least one hour apart.
Would you like your at-sea scale inspection on a different date and time than the video inspection? □ Yes □ No							If YES, what date and time?
Will repair company be on site at inspection? □ Yes □ No							Company Name:
Prior to the at scale inspection make sure: The scale is installed in a rigid and level manner The display & printer are connected and operational Belts leading to the scale are connected and operational (not applicable to platform and hanging scales) Test weights & test weight certification documents are available for inspection (platform scales only) A crew member will be available to help the inspector transport test materials and conduct the testing

_________________________________________________________________________________________

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 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.

____________________________________________________________________________________________________________

Inspection Request for Flow Scale Video Monitoring System

Page 2 of 2