Electronic Ballast Water Management Practices Report  Form

This form is authorized by Section 3103 of the Michigan Natural Resources and  Environmental Protection Act, 1994 PA 451, as amended. Completion of this form is required of any vessel owner and/or operator operating on the Great Lakes or St. Lawrence waterway. Any persons who have contracts for transportation of cargo with an operator that does not report the use of the approved ballast water management practices are not eligible for a new grant, loan, or award administered by the Michigan Department of Environmental Quality (MDEQ).

Completion of this form will certify compliance with the Michigan Ballast Water Discharge requirements.

1. Vessel Information

 

Vessel Name

Owner  

IMO Number

Flag

Vessel Type


2. Ballast Water Management

Yes

No

For oceangoing vessels:    
During the last 12 months, has the vessel complied with the ballast water management practices proposed by the Shipping Federation of Canada (Attachment A)?
Is the vessel currently complying with the ballast water management practices proposed by the Shipping Federation of Canada (Attachment A)?
For nonoceangoing vessels:    
During the last 12 months, has the vessel complied with the ballast water management practices proposed by the Lake Carrier's Association and the Canadian Shipowners' Association (Attachment B)?
Is the vessel currently complying with the ballast water management practices proposed by the Lake Carrier's Association and the Canadian Shipowners' Association (Attachment B)?

3. Responsible Officer's Signature
Name:         

Title:           

Date:          

Address:     

Email:         

Phone:        

Fax:            
 


The MDEQ will compile a list of vessels complying with the ballast water management practices identified above and post the list on the MDEQ Web site at:

http://www.michigan.gov/deq/0,1607,7-135-3307_3667_8278-155135--,00.html

EQP 0600 (1/12)


Instructions for the Electronic Ballast Water Reporting Form

Section 1. Vessel Information

Vessel Name:  Enter the name of the vessel.

IMO Number:  Identification number of the vessel used by the International Maritime Organization.

Owner:  Name of the registered owner(s) of the vessel. If under charter, enter operator name.

Vessel Type:  Select specific vessel type. Use the following abbreviations: bulk, roro, container, tanker, passenger, oil/bulk ore, general cargo, reefer, or other.

Flag:  Identify the full name of the country under whose authority the ship is operating. No abbreviations please.

Oceangoing Vessel:  Indicate whether the vessel is an oceangoing vessel operating on the Great Lakes and the St. Lawrence waterway. Check Yes or No.

Nonoceangoing Vessel:  Indicate whether the vessel is a nonoceangoing vessel operating on the Great Lakes and the St. Lawrence waterway. Check Yes or No.

Section 2. Ballast Water Management

For oceangoing vessels:

  • Indicate whether during the last 12 months the vessel complied with the ballast water management practices that were proposed by the Shipping Federation of Canada (Attachment A). Check Yes or No.
  • Indicate whether the vessel is currently complying with the above ballast water management practices. Check Yes or No.

For nonoceangoing vessels:

  • Indicate whether during the last 12 months, the vessel complied with the ballast water management practices that were proposed by the Lake Carrier's Association and the Canadian Shipowners' (Attachment B). Check Yes or No.
  • Indicate whether the vessel is currently complying with the above ballast water management practices. Check Yes or No.

Section 3. Title and Signature

Responsible officer's name and title:  The responsible officer may be an owner, operator or agent. Enter name, title, address, email address, phone number and fax number, if available.

This form may be submitted electronically or a printable version can be accessed at www.michigan.gov/documents/deq/deq-ogl-ballastform_249365_7.doc and submitted to:

Office of the Great Lakes
Ballast Water Reporting Program
Department of Environmental Quality
P.O. Box 30473
Lansing, Michigan 48909-7973

Also, the printable form may be submitted by fax to 517-335-4053. 
Please send a completed form for each vessel.

Any questions regarding this form should be forwarded to the Office of the Great Lakes at 517-284-5035.