Notification of Major Escapement Event

OMB Control No. 0648-0703

Expiration Date:

NOTIFICATION OF MAJOR ESCAPEMENT EVENT GULF OFFSHORE AQUACULTURE OPERATIONS

FOR OFFICE USE ONLY
Date Received
Gulf Aquaculture Permit Number
Reviewer Initials and Date

Permittees must notify NOAA Fisheries via web form (website TBD) within 24 hours of a major escape event.

Part 1 – Contact Person Information

LAST NAME FIRST NAME MIDDLE NAME Suffix (Sr., II, etc.) MAILING ADDRESS Apt/Suite #

CITY STATE COUNTY ZIP CODE

WORK TELEPHONE NUMBER CELL PHONE NUMBER GULF AQUACULTURE PERMIT NUMBER

_{Part 2 – Event Information}

Provide the GPS coordinates for the location where the event occurred. Report coordinates

as Degree Minutes to at least the third decimal place (e.g., DD MM.MMM).

: AM / PM

/ /

DATE OF EVENT (MM/DD/YYYY) TIME OF EVENT

LATITUDE (DEGREE MINUTES TO THIRD DECIMAL PLACE) LONGITUDE (DEGREE MINUTES TO THIRD DECIMAL PLACE)

List the number, size, and percent of fish, by species that escaped. Attach additional sheets as necessary.

1)	Genus Average Total Quantity Number of Escaped Percent Escaped and Species Length (inches) Escapees (per species)
1) 2)
2)
3)
4) _________	_______________________________________________________________________ __
5) ________	_______________________________________________________________________
5)

Provide information on the duration, specific location, number of cages or systems involved, and cause(s) of the escapement.

Provide information on the action(s) which are being taken to address the escapement.

_{Part 3 – Signature}

I hereby declare under penalty of perjury that the foregoing information is true and correct (28

U.S.C. section 1746; 18 U.S.C. section 1621; 18 U.S.C. section 1001).

PERMIT OWNER SIGNATURE DATE SIGNED (MM/DD/YYYY)

_{/ /}

PRINTED NAME POSITION IN COMPANY (if applicable)

Public reporting burden for this collection of information is estimated to average 30 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 other suggestions for reducing this burden to PRA Officer, National Marine Fisheries Service. F/SER26, 263 13th 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. Non-confidential information may be released via a NOAA Fisheries website. Non-confidential information means: Name, Street Address, City, State, Zip Code, Effective Date of Permit, Permit Types, Vessel Name, Vessel Identification Number, and in the case of a “for hire” vessel the Passenger Capacity, or individual, corporate and lease holders of permits. All other data submitted will be handled as confidential material in accordance with NOAA 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 OMB Control Number.

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