Fillable APPLICATION FOR PERMISSION TO IMPORT SHELLFISH

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APPLICATION FOR PERMISSION TO IMPORT SHELLFISH

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APPLICATION FOR PERMISSION TO IMPORT SHELLFISH
Name of Applicant: _____________________________________________
A
ddress:
_
____________________________________________
_
____________________________________________
Phone Number:
(
_
___
)
_
_____ -
_
________
Email Address:
_______________________________
Seed to be Imported:
_
______________________________
_
_____________________________
_
Common Name
Scientific Name (Species)
Seed Source / Location: _____________________________________________
(Hatchery Info.)
_____________________________________________
_____________________________________________
NJ Nursery Grounds (if applicable):
___________________ ____________________ _______________________
Nursery Location Water Classification
Leased Ground to Be Planted: ___________ __________ ________________________________
Section Lot # Location (ex., Delaware Bay)
Description of plan for seed: ______________________________________________________
Quantity / Size: ________________________
_____________________
Total Number Estimated Size (mm)
I certify that the information that I provided within this document is true and is in
accordance with the N.J.S.A 50:1-34 and 50:1-35 pertaining to permission to plant or
lodge shellfish.
__________________________________________________ _________________________
Applicant’s Signature Date
Please submit application to Megan Kelly with the Bureau of Shellfisheries – Megan.Kelly@dep.nj.gov
DEPARTMENT OF ENVIRONMENTAL PROTECTION
PHILIP D. MURPHY NATURAL AND HISTORIC RESOURCES CATHERINE R. MCCABE
Governor DIVISION OF FISH AND WILDLIFE Commissioner
P.O. BOX 420; MAIL CODE: 501-03
TRENTON, NJ 08625-0420
SHEILA Y. OLIVER TEL: (609) 292-2965; FAX: (609) 984-1414
Lt. Governor
VISIT OUR WEBSITE: WWW.NJFISHANDWILDLIFE.COM
New Jersey is an Equal Opportunity Employer lPrinted on Recycled Paper and Recyclable
click to sign
signature
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*
INTERNAL NHR USE ONLY*
Date Received: ________________________
Administrative Support Staff: ____________________________________
Histopathology Report Attached
Yes
No
Histopathology Report Receipt Date: ______________________________
Histopathology Review – Recommendation
Approve
Deny
_
________________________
_
_
__________
_
Reviewin
g
Biolo
g
ist
Date
Management Consent
______________________________________
_____________________
Joseph A. Cimino Date
Administrator
Marine Fisheries Administration
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APPLICATION FOR PERMISSION TO IMPORT SHELLFISH

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Completed 13 May 2021

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