Aquaria Attachment Form

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Aquaria Attachment
A Fish Resource Permit classified as "holding" will allow the transport and live holding
of specimens to be contained in aquaria.
Specimens are not to be released.
Carcasses
must be disposed in a manner approved by the department.
All aquarium systems (open and
closed) may be inspected and will require approval by an ADF&G Fish Health Services
Pathologist.
_____________________________ _______________________________________
(Name of Applicant)
(Organization or School)
________________________________________________________________________________
(Mailing Address)
(City, State, Zip Code)
Telephone: ______________ (work)
________________ (fax) __________________________(email)
******************************************************************************************
The fish or eggs will be reared in:
[
] recirculating aquarium
[
] flow-through aquarium
[
] other (describe incubation and rearing system, use the back of this page)
Source of water for rearing and proposed effluent discharge:
____________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Isolation measures planned to control disease during transport, including description of
container, water source, and method and plan for transport:
_____________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
History of previous transports of this stock: ____________________________________________
__________________________________________________________________________________________
Disease history of stock to be transported: ______________________________________________
__________________________________________________________________________________________
Final disposition:
[
] destroyed as a result of experimentation
[
] destroyed at termination of project
and approximate date of disposition:
____________________ to ___________________, 19
I certify that the statements made in this report are true and that I have followed the
guidelines as originally specified in my approved permit .
_____________________________________________________
______________________________
Signature
Date

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