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 California Sea Traffic Management

Calculated Time of Arrival (CTA) Queue

    Prepared By:

    Contact Information

    Company Information

    Agent Information:

    Contact Information

    Mailing Address


    Qualified Individual Information:

    Contact Information

    Mailing Address


    Operator Information:

    Contact Information

    Mailing Address

    Vessel:

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    Vessel Name *

    Vessel Type *

    IMO Number *

    MMSI *

    E-mail (24 Hr) *

    Sat Phone (24 Hr) *

    Review and Submit:

    Comments (optional)

    Prepared By

    Contact Information

    Company Information

    • First Name:

    • Last Name:

    • Title:

    • [cf7_recall "prep-first-name"]

    • [cf7_recall "prep-last-name"]

    • [cf7_recall "prep-title"]

    • Role:

    • Company Name:

    • E-mail:

    • Phone:

    • [cf7_recall "prep-role"]

    • [cf7_recall "prep-company-name"]

    • [cf7_recall "prep-email"]

    • [cf7_recall "prep-phone"]

    Agent

    Contact Information

    Mailing Address

    • Agent:

    • E-mail:

    • Phone:

    • [cf7_recall "ag-name"]

    • [cf7_recall "ag-email"]

    • [cf7_recall "ag-phone"]

    • Address Line 1:

    • Address Line 2:

    • Address Line 3:

    • Address Line 4:

    • City:

    • State/Province/Region:

    • Zip/Postal Code:

    • Country:

    • [cf7_recall "ag-address-1"]

    • [cf7_recall "ag-address-2"]

    • [cf7_recall "ag-address-3"]

    • [cf7_recall "ag-address-4"]

    • [cf7_recall "ag-city"]

    • [cf7_recall "ag-state"]

    • [cf7_recall "ag-zip"]

    • [cf7_recall "ag-country"]

    Qualified Individual

    Contact Information

    Mailing Address

    • QI Name:

    • E-mail:

    • Phone:

    • [cf7_recall "qi-name"]

    • [cf7_recall "qi-email"]

    • [cf7_recall "qi-phone"]

    • Address Line 1:

    • Address Line 2:

    • Address Line 3:

    • Address Line 4:

    • City:

    • State/Province/Region:

    • Zip/Postal Code:

    • Country:

    • [cf7_recall "qi-address-1"]

    • [cf7_recall "qi-address-2"]

    • [cf7_recall "qi-address-3"]

    • [cf7_recall "qi-address-4"]

    • [cf7_recall "qi-city"]

    • [cf7_recall "qi-state"]

    • [cf7_recall "qi-zip"]

    • [cf7_recall "qi-country"]

    Operator

    Contact Information

    Mailing Address

    • Operator:

    • E-mail:

    • Phone:

    • [cf7_recall "op-name"]

    • [cf7_recall "op-email"]

    • [cf7_recall "op-phone"]

    • Address Line 1:

    • Address Line 2:

    • Address Line 3:

    • Address Line 4:

    • City:

    • State/Province/Region:

    • Zip/Postal Code:

    • Country:

    • [cf7_recall "op-address-1"]

    • [cf7_recall "op-address-2"]

    • [cf7_recall "op-address-3"]

    • [cf7_recall "op-address-4"]

    • [cf7_recall "op-city"]

    • [cf7_recall "op-state"]

    • [cf7_recall "op-zip"]

    • [cf7_recall "op-country"]

    Vessel(s)

    Vessel 1 Information

    Vessel 2 Information

    • Name:

    • Type:

    • IMO:

    • MMSI:

    • E-mail:

    • Sat Phone:

    • [cf7_recall "vslName1"]

    • [cf7_recall "vslType1"]

    • [cf7_recall "vslIMO1"]

    • [cf7_recall "vslMMSI1"]

    • [cf7_recall "vslemail1"]

    • [cf7_recall "vslphone1"]

    • Name:

    • Type:

    • IMO:

    • MMSI:

    • E-mail:

    • Sat Phone:

    • [cf7_recall "vslName2"]

    • [cf7_recall "vslType2"]

    • [cf7_recall "vslIMO2"]

    • [cf7_recall "vslMMSI2"]

    • [cf7_recall "vslemail2"]

    • [cf7_recall "vslphone2"]