International Dolphin Conservation Program Vessel Operat

OMB Control No.
0648-0387
Expires:
January 31, 2012

OPERATOR PERMIT APPLICATION - 2012
No Fee Required
The collection of information is mandated by the Marine Mammal Protection Act (16 U.S.C. 1371) and by implementing regulations
contained at 50 CFR §216.24(b)(2). The information supplied on this form will be used by the National Marine Fisheries Service
to authorize the incidental take and to alert vessel owners of applicable rules and regulations regarding the permit for
the taking of marine mammals incidental to commercial purse seine fishing for yellowfin tuna in the eastern tropical Pacific
Ocean. The name of the operator supplied on this form may be released under the Freedom of Information Act. All other
information supplied on this form are considered proprietary and therefore subject to data confidentiality restriction of
National Oceanic and Atmospheric Administration Administrative Order 216-100.

1. OPERATOR INFORMATION
OPERATOR NAME:
(First, Middle, Last)

HOME ADDRESS:
TELEPHONE:
FAX:

2. PERMIT INFORMATION
VESSEL NAME(S):

DATE, LOCATION, AND PROVIDER OF MOST RECENT TUNA PURSE SEINE MARINE MAMMAL SKIPPER WORKSHOP:

OTHER FEDERAL, STATE, AND COMMERCIAL LICENSES HELD BY OPERATOR:
(include type, identification numbers, and expiration dates)

I declare that the information in this application is true and complete.
APPLICANT'S SIGNATURE
-or-

DATE

APPLICANT'S REPRESENTATIVE

DATE

Upon Completion, submit to: National Marine Fisheries Service; Protected Resources Division; 501
West Ocean Blvd., Suite 4200; Long Beach, CA 90802-4213
Public reporting burden for this collection of information is estimated to average 10 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 aspect of this
collection of information, including suggestions for reducing this burden, to Regional Administrator, Southwest Region,
National Marine Fisheries Service, 501 West Ocean Boulevard, Suite 4200, Long Beach, California, 90802-4213, (562) 980-4001.
The National Marine Fisheries Service may not conduct or sponsor, and a person is not required to respond to, a collection
of information unless it displays a current and valid OMB Control number.