CG-5662 Annual Ballast Water Summary Report - Online

Annual Ballast Water Summary Report

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National Ballast Information Clearinghouse
*** DRAFT *** DRAFT *** DRAFT *** DRAFT *** DRAFT *** DRAFT *** DRAFT ***
OMB Control Number 1625-0069
Exp. Date: 08/31/2018

Annual Ballast Water Summary Report for 2015 (see 33 CFR §151.2060)
(For vessels operating exclusively between ports in a single Captain of the Port Zone)
1. Vessel Information
Vessel name:
Vessel IMO number:
Fill in vessel information from IMO number

Call sign:
Vessel owner/operator:
Vessel type:

Select vessel type

Vessel tonnage (GT):
Total ballast water capacity:

meters^3

Number of ballast tanks on ship:
Ballast water treatment system:
2. Operational Information
COTP Zone of operation:

Select Zone

Primary port of ballast water loading:
Primary port of ballast water discharge:
Estimated times ballast water was discharged:
Estimated volume of each ballast discharge:
3. Certification
Vessel complies with the requirements
of 33 CFR §151.2050:

meters^3

Agreed

Authorized representative (name and title):
Contact information:
Submit report

Questions or comments? Please contact us: [email protected]

http://si-pweb11.si.edu/cgi/annual

09/09/2015