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U.S. DEPARTMENT OF HOMELAND SECURITY U.S. COAST GUARD CG-3752 (Rev. 6-04)

APPLICATION FOR INSPECTION OF U.S. VESSEL

FORM APPROVED OMB NO. 1625-0002

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The Coast Guard estimates that the average burden for this report is 15 mins. You may submit any comments concerning the accuracy of this burden estimate or any suggestion reducing the burden to: Commandant (G-MOC), U.S. Coast Guard, Washington, DC 20593-0001 or Office of Management and Budget, Paperwork Reduction Project (1625-0002), Washington, DC 20503. Address to reply to: TO: Officer in Charge, Marine Inspection

Marine Inspection Zone The undersigned applies to have the Motorboat named inspected under the laws of the United States; to be employed as a Cargo Vessel Tank Vessel MODU Barge Steam Vessel Other ( Indicate) Official or Award No. Passenger Vessel (No. of Passengers Other (Indicate) ) Motor Vessel

TELEPHONE NUMBER: DATE:

on the following route: (Waters, Geographical limits)

Liquid cargo in bulk

will

will not be carried as follows:

Flammable or Combustible (Indicate grade) Chemicals (Indicate) Length of vessel Hull material: Steel ft. Other (Indicate)

Vessel will be at (Port, Pier, etc.) The current Certificate of Inspection expires on Inspection is desired on Cargo Ship Safety Construction Certificate to be issued by Vessel is is not to be classed. ABS has Other (Indicate) has not been made. I further certify that I have instructed . ABS USCG. .

If classed, indicate Classification Society: I CERTIFY that previous application for this inspection

the master to present the vessel ready in all respects for the above requested inspection on the date specified. I understand that if this inspection is to be conducted at foreign port or place the vessel owners will be billed for the costs incurred in accordance with 46 USC 385b-1.

(Signature)

(Title) PREVIOUS EDITION IS OBSOLETE

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