Aquacultured Live Rock Deposit Harvest Report

U.S. DEPTOF COMMERCE,

NOAA

263 13TH Avenue South

HARVEST OF AQUACULTURED LIVE

St. Petersburg, FL 33701
Toll Free 877/376-4877 8:00 am
727/824-5326 (8:00 am

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OMBControINo.0648-0205;
Expiration Date: 04/30/2017

1’D

REPORT FOR THE DEPO’T

NMFS PERMITS OFFICE, F/SER14

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Forrsreviseds8/14/2014

ROCK

4:30 pm ET

1
•jT

4:30 pm ET)

http://sero.nmfs.noaa.gov

FQR OFFICE USE ONLY
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Reviewer Initials and
Date Entered

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INSTRUCTIONS: Complete section 1 and either section 2 or3with all information. Please sign, date, and pdnt your name in
section 4. You must fill out a separate report for each deposit or harvest activity. Do not list deposits or harvests done on the
same date on the same report. You must make a separate report for each deposit of materials that are from different sources,
suppliers and/or geographic origin, even if made on the same date. If not originally approved, then provide a new sample of rock.
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I PERNHT HOLDER INFORMATION

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Permit holder as shown on the permit

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Site number the material was
deposited on or harvested from

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USOG Document Number or State registration
Number of the Primary Vessel the permit is used on

AQU-

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2 DEPOSIT INFORMATION

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Name of the source/supplier of the deposited material
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Mailing Address

Apt/Suite

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Physical Address

Apt/Suite

#

City

State

County/parish

Zip Code

Country

State

County/parish

Zip Code

Country

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City

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Check box if same as Mailing Address

Description of the deposited material

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Type and specific geographic origin

YES

NO

rock been provided to NMFS? If not,
then a sample should be provided to NMFS with this form.
Has a sample

Date Deposited (dd/mm/yyyy)

Average Dimensions (inches)

3. HARVEST INFORMATION

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( e.g. 12”

x

of this

12”)

Total Weight

Deposited (Pounds)
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FILL OUT ONLY IF LANDED OUTSIDE THE STATE OF FLORIDA

NOTE: If landing INSIDE the state of Florida, you must report to the Fisheries Department Monitoring Section of the Florida Fish and Wildlife Research
Institute using standard form #33-610 (Marine Fisheries Trip Ticket). Call the trip ticket office at 727/896-8626 for more information.

Name of the purchaser
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of the

harvested material
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Mailing Address

Physical Address

flcheck box

if

same

City

State

County/parish

Zip Code

Country

#

City

State

County/parish

Zip Code

Country

Apt/Suite

as Mailing Address
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Date Harvested (mm/dd/yy)

Total Weight

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L.____

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Price Per

Harvested (pounds)

Total Dollar

Pound

Value

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4. SiGNATURE
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GNATURE
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PRINTED NAME

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Apt/Suite #

POSITION IN COMPANY

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DATE

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the
time for reviewing 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
th
suggestions for reducing this burden to PRA Officer, National Marine Fisheries Service, F/SER26, 263 13
Avenue South,
St. Petersburg, FL 33701.
The National Marine Fisheries Service requires this information for the conservation and management of marine fishery
resources. The data reported will be used to develop, implement, and monitor fishery management activities for a variety
of other uses. Responses to this collection are required to obtain or retain a fisheries permit under the Magnuson
Stevens Act. Confidential name and address information will be released via a NOP’A Fisheries website. All other data
submitted will be handled as confidential material in accordance with NOA Administrative Order 216-100, Protection of
Confidential Fishery Statistics. Notwithstanding any other provisions of the law, no person is required to respond to, nor
shall any person be subjected 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 0MB Control Number.
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