Vessel Of Concern Reporting Form - Alaska Department Of Natural Resources

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Alaska Vessel of Concern Reporting Form 
 
 
INSTRUCTIONS: Fill out the following form to the best of your ability. If unknown, write unknown. Upon completion, submit to the 
Alaska Department of Natural Resources, along with copies of photos if possible: 
Alaska Dept. of Natural Resources   ATTN: ADV Reporting  
email: dnr.adv@alaska.gov 
Submit Via Email
th
550 W 7
 Ave Ste 900c, Anchorage, AK 99501‐3577      
fax: 907‐269‐8913 
 
IF THERE IS AN EMERGENCY: Contact the National Response Center and they will ensure the proper agencies are contacted for 
response. 800‐424‐8802 
 
BE ADVISED OF THE FOLLOWING: Derelict vessels not only pose a hazard to the environment, but also pose many hazards to people. 
Please keep this in mind when gathering information and remain a safe distance from the vessel. DO NOT go onboard unless you are 
 
trained to do so. 
 
REPORTING 
New Entry 
Update to existing entry   
Agency Case Number/ID (if applicable) ______________ 
 
Reported by_______________________________ Email and Phone________________________________________________  
 
Date & Time of Report _____________________ Reporting Organization ____________________________________________ 
     
 
VESSEL INFORMATION 
 
Vessel Name _________________________________________ 
Current registration?  
Yes 
No 
Unk 
 
Registration Number & Expiration_________________________ 
Photos Available?  
Yes 
No 
 
ADF&G/Other ID Marks________________________________________________________________________________________ 
 
Hull Type (circle one): 
 
Steel 
     Wood 
Fiberglass 
Aluminum 
Other:__________________ 
 
Length ________________ Hull Color ____________________ Superstructure Color _____________________ 
 
Trim Color ________________________   Vessel Type (circle one): 
Commercial  
Recreational 
Unknown 
 
Vessel Subtype (circle one): 
Cruising            Sailing 
Fishing         Passenger        Barge        Tug  Processing 
 
General Location______________________________ 
Nearest Community __________________________________ 
 
Lat/Long__________________________________________________ Approximate Water Depth_________________ 
 
Vessel is (circle one): 
Afloat   
Aground   
Tidal Dependent   
Submerged 
 
Fuel Type: ______________________ 
Total Fuel Capacity ___________________   Number of Tanks______________ 
 
Fuel Vent Location ________________ 
Description/Qty of all HAZMAT ______________________________________ 
 
OWNER INFORMATION 
 
Last Known Owner ____________________________________  
Has the owner been contacted:   Yes 
No 
 
 
Phone_____________________ Email _____________________ 
Method of contact and date(s) _________________________ 
 
Address_______________________________________________ 
__________________________________________________ 
 
ADDITIONAL NOTES 
  
 
OVER  
 

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