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Application for Cultivation of Atlantic Salmon
   
Boothbay Laboratory, PO Box 8 W. Boothbay Harbor ME 04575
Voice : 207-633-9502, FAX: 207-633-9579

 

  PLEASE TYPE OR PRINT                           Date of Request:                      

Company Name:                                                                                                                                      

Manager or Contact Person:                                                                                                               

Address:                                                                                                                                                 

City:                                                                                               State                         Zip                  

Business Phone:                              FAX                          email:                                 

Hatchery Name:                                                Watershed/River                                                         

GPS Coordinates (If Known)                              Total Capacity of Facility:                              

Fish Health Inspector/Veterinarian:                                                                                                       

Fish Lot#            Fish Strain              Egg Source             Transfer Permit           Fish Quantity                                   

                                                                                                                                                              

                                                                                                                                                              

                                                                                                                                                              

                                                                                                                                                               

                                                                                                                                                                  

I understand that all shipments of fish transported from the facility must be tagged with my name, the companies name and address and date.  (initial)                                                               

I understand that all shipments of fish transported from the facility must be accompanied by a copy of a current approved transfer permit for the lot being transferred: (initial)                         

I understand that no live fish or gametes may be imported into the State of Maine without  written permission of the Commissioners of DMR  .  (initial)                                                     

I understand that the facility licensee must keep invoices for all shipments of fish sold or purchased and must make them available for inspection by the Commissioner or his authorized agent: (initial)                                                      

 

Signed                                                                                                                 Date:                        

 

 

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