OMB number 1625-0069
Exp. Date: 31-Dec-2018

Annual Ballast Water Summary Report (see 33 CFR 151.2060(e))

(for vessels operating exclusively between ports in a single Captain of the Port Zone)

1. Vessel Information    >>    2. Operation    >>    3. Review

Reporting Year: 2017
Vessel Information
Vessel name:
Vessel ID number:
Call sign:
Country of Registry:
Vessel owner/operator:
Vessel type:
Vessel tonnage (GT):
Total ballast water capacity:
Number of ballast tanks on ship:
Operational Information
COTP Zone of operation:

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