One Time Report

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Vessel General Permit – One Time Permit Report

C. Vessel Information:
Vessel Name:
Vessel Identifier:
Flag State:
Vessel Gross Tonnage: Gross Tons Gross Registered Tons
Vessel Length: Feet Meters
Type of Vessel:
Commercial Fishing Vessel with Ballast Water
Medium Cruise Ship (100 to 499 passengers)
Large Cruise Ship (500+ passengers)
Large Ferry
Barge
Oil or Gas Tanker
Research Vessel
Rescue Vessel
Other:______________________________

D. Certification Information:
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with
a system designed to assure that qualified personnel properly gathered and evaluated the information contained therein. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information contained is, to the best of my knowledge and belief, true, accurate, and complete. I have no personal knowledge that the
information submitted is other than true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations.

Print Name:
Title:
Signature:
Date:
E-mail:
E. Questions:
1. Have all the monitoring conditions and visual inspection requirements in this General Yes No
Permit (Part 4 and Part 5 if applicable) that apply to your vessel been met since the
beginning of its coverage? If you answered “NO,” please check which requirements
were not met in the space provided below:
Routine inspections
Annual inspections
Analytical monitoring (if applicable)
Drydock inspection (if applicable)
Other (please explain)

2. Have any corrective actions required by this General Permit (Part 3 of this Permit) that Yes No
apply to your vessel been necessary since the beginning of its coverage? If you answered
“Yes,” please check how many corrective actions have been necessary for your vessel
since the beginning of its coverage.
1-5 corrective actions
6-10 corrective actions
11-20 corrective actions
21-30 corrective actions
More than 30 corrective actions
3. Have modifications requiring new parts or the installation of new equipment been made Yes No
to your vessel since the beginning of its coverage under this General Permit for the
purpose of meeting the conditions or limitations (Part 3) of this Permit? If you answered
“YES,” then how many modifications have you made?
One
Two
Three or more
4. Have any standard operating procedures for your vessel been modified since the Yes No
beginning of its coverage under this General Permit for the purpose of meeting the
conditions or limitations? If you answered “YES,” then how many?
One
Two
Three or more
5. Have you conducted all the environmental training related to your vessel that is required
under this General Permit since the beginning of its coverage?
Required Training For Crew Yes No
Required Training For Passengers (if not applicable, leave blank) Yes No

6. Have you experienced any undue delays in operation of your vessel since the beginning Yes No
of its coverage under this General Permit that are directly the result of compliance with
the requirements of the Permit? If you answered “YES,” please provide a brief
description of each instance in the space provided below.
Instructions for Completing the One Time Report for Discharges Incidental to the Normal Operation of
a Vessel Under the NPDES Vessel General Permit

Who must file a One Time Report with EPA? Completing the One Time Report
To complete this report, type or print in the
The Vessel General Permit (VGP) requires appropriate areas only. Please make sure you complete
owner/operators to submit a one time report for each all questions. Make sure you make a photocopy for
vessel between 30 months and 36 months after your records before you send the completed original
obtaining permit coverage (see Part 4.4.4 of the VGP). report to the address above. You may also use this
For instance, if an owner/operator received VGP paper report as a checklist for the information you will
coverage on December 19, 2008, then the need when filing a one time report electronically via
owner/operator is required to submit a one time report EPA’s Vessel General Permit one time report electronic
between June 19, 2011 and December 19, 2011. All system.
owner/operators are required to submit one time
reports regardless of whether or not Notices of Intent Section A. Permit Number
(NOIs) were required to be submitted to EPA.
 This field is for permittees’ Notice of Intent
Where to File the One Time Report (NOI) tracking number. If a permittee was not
required to submit a NOI in accordance with
EPA encourages you to complete the Vessel General Part 1.5 of the VGP, then this field should be
Permit (VGP) one time report electronically via the kept blank.
internet. EPA’s Vessel General Permit One Time Report
Electronic System can be found at Section B. Vessel Owner/Operator Information
http://www.epa.gov/npdes/vessels/vesselsreporting.cfm.
 Provide the full legal name of the person, firm,
Filing electronically helps ensure that your one time
public organization, or other entity that is the
report is complete and significantly reduces any
owner/operator of the vessel described in this
processing delays. If you choose not to file
report.
electronically, you must send the one time report to
 Provide the Employer Identification Number
one of the addresses below.
(EIN from the Internal Revenue Service (IRS)),
commonly referred to as your taxpayer ID
One Time Reports sent regular mail
EPA Vessels Notice Processing Center (4203M) number. If the owner/operator does not have
an EIN, enter the International Maritime
USEPA
Organization (IMO) Registered Owner or
1200 Pennsylvania Avenue, NW
Company (DOC) number. Please designate the
Washington DC 20460
type of ID number entered. If the
(202) 564-9545
owner/operator does not have an EIN or IMO
Owner or company number, enter “NA” in the
One Time Reports sent overnight/express mail
space provided.
EPA Vessel Notice Processing Center
 Provide the name of the Certifying Official.
EPA East Building, Rm 7420
 Provide the owner/operators’ mailing
1201 Constitution Ave, NW
address, telephone number, fax number
Washington DC 20004
(optional), and email address.
(202) 564-9545
Correspondence, if necessary, will be sent to
this address.
If you have any questions about whether you need to
file a one time report or questions about completing
Section C. Vessel Information
the report, refer to
http://www.epa.gov/npdes/vessels/vesselsreporting.cfm  Provide the vessel’s official or legal name, if
or call 1-866-352-7755 (8:00 a.m. – 5:00 p.m. EST). applicable. If the vessel does not have a name,
enter “NA” in the space provided.
If you file a paper one time report, please submit the  Provide the vessel’s identification, registered
original with a signature in ink – Do Not Send Copies. identification number, or IMO Ship number,
Faxed copies will not be accepted. as applicable.
 Provide the flag state or port of registry. If the
EPA will review paper one time reports for vessel does not have a flag state or port of
completeness, but no confirmation of receipt will be registry, enter “NA” in the space provided.
provided. If the paper one time report is incomplete,  Enter the vessel weight in gross tons or gross
EPA may send the report back to the preparer for registered tons and specify the units entered.
resubmission.  Enter the vessel length in feet or meters and
specify the units entered.
  Select the type of vessel by checking the Section E. Questions
appropriate button. Only the vessel types
required to meet additional, vessel type- 1. Indicate whether all monitoring conditions
specific permit requirements are listed; all and visual inspection requirements in this
other vessel types should select “other” and General Permit (Part 4 and Part 5 if applicable)
enter the vessel type in the space provided.
that apply to your vessel have been met since
Section D. Certification Information the beginning of its coverage. If you answered
“No,” please check which requirements were
Carefully read the certification statement. By not met in the space provided.
completing and submitting the one time report, the
2. Indicate whether any corrective actions
owner/operator certifies that all information in the one
time report is correct. Enter the certifier’s printed required by this General Permit (Part 3 of the
name, title and email address. Sign and date the report. Permit) that apply to the vessel have been
(CAUTION: An unsigned or undated one time report will necessary since the beginning of its coverage.
not be accepted by EPA and will be returned to the If you answered “Yes,” please check how many
user.) Federal statutes provide for severe penalties for corrective actions have been necessary for the
submitting false information on this one time report. vessel since the beginning of its coverage.
Federal regulations require this report to be signed as
follows: 3. Indicate whether any modifications requiring
For a corporation: by a responsible corporate officer, new parts or the installation of new
which means: equipment have been made to the vessel
(i)president, secretary, treasurer, or vice-president of since the beginning of its coverage under this
the corporation in charge of a principal business General Permit for the purpose of meeting the
function, or any other person who performs similar conditions or limitations (Part 3) of this
policy or decision making functions for the corporation,
Permit. If you answered “Yes,” check how
or
(ii)the manager of one or more manufacturing, many modifications have been made.
production, or operating facilities, provided the 4. Indicate if any standard operating procedures
manager is authorized to make management decisions for the vessel have been modified since the
which govern the operation of the regulated facility beginning of its coverage under the General
including have the explicit or implicit duty of making Permit for the purpose of meeting the
major capital investment recommendations, and
conditions or limitations. If you answered
initiating and directing other comprehensive measures
to assure long term environmental compliance with “Yes,” check how many in the space provided.
environmental laws and regulations; the manager can 5. Indicate whether all environmental training
ensure that the necessary systems are established or related to the vessel that is required under
actions taken to gather complete and accurate this General Permit has been conducted for
information for permit application requirements; and
crew since the beginning of its coverage.
where authority to sign documents has been assigned
Indicate whether all environmental training
or delegated to the manager in accordance with
corporate procedures; related to the vessel that is required under
For a partnership or sole proprietorship: by a general this General Permit has been conducted for
partner or the proprietor; or passengers since the beginning of its
For a municipal, State, Federal, or other public facility: coverage. If training for passengers is not
by either a principal executive or ranking elected applicable, please leave this field blank.
official.
6. Indicate whether the vessel has experienced
undue delays in operation since the beginning
of its coverage under this General Permit that
are directly the result of compliance with the
requirements of the Permit. If you answered
“Yes,” please provide a brief description of
each instance in the space provided.