Esquimalt Graving Dock Regulations

Department of Public Works and Government Services, Esquimalt, British Columbia

I (We), the undersigned, hereby make application for the vessel described below to be dry-docked in the Dry Dock, for the purpose and time stated, on theday of, 20

Name of Vessel
Port of Registry
Owner’s Name
Owner’s Address
Master’s Name
Master’s Address
Agent’s Name
Agent’s Address
Dockmaster’s Name
Gross Tonnage
Length, Overall
Length between Perpendiculars
Breadth, Extreme
Draft, Forward
Draft, Aft
Type of Vessel (screw, sailing, not self-propelled, etc.)
Engines: Steam, Gasoline or Oil
Fuel: Coal or Oil
Keel: Bar or Flat (If bar, state depth)
Rise of Floor Amidships

Is there any explosive matter on board? (If so, describe)

Does this vessel carry, or did it carry on its last voyage, any oil with a flash-point below 23°C?

Is there any oil escaping from the vessel? (If so, to what extent?)

Estimated number of days dry dock is required

Purpose for which dry dock is required

Special features of ship, such as the length of “cut up” forward and aft, camber of keel, if any, and underwater form (State if “usual”; if “unusual”, give particulars)

(1) 

(Signature of Agent)

(2) 

(Signature of Witness)

Date20