Cg 4260 R Ev 6 04 Form 2004

Name: Cg 4260 R EV 6 04 Form - Fill Out and Sign Printable PDF Template | signNow
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CODE OF AGENT OR CHARTERER DATE(S) AND TIME(S) OF OPERATION I UNDERSTAND and will comply with current safety laws, rules and regulations of the United States, the State, County, City and Port Authority while handling hazardous materials. (See Page 2.) TITLE (Authorized Company Representative) DATE SIGNATURE PERMIT THE ABOVE REQUEST IS: APPROVED APPROVED WITH THE FOLLOWING CONDITIONS EXCEPTIONS/CONDITIONS DATE SIGNATURE (Captain of the Port, U.S. Coast Guard) INSPECTION (VESSEL LOADING...

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