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(Date)
Revised 4/23/07
EXPLANATION SHEET
FOR THE ARTIFICIAL
REEF MATERIALS CARGO MANIFEST FORM
The attached artificial reef cargo manifest has been developed in compliance with subsection
379.249(6)(b), Florida Statutes, which states that:
“It is unlawful for any person to: store, possess or transport on or across state waters any materials
reasonably suited for artificial reef construction and stored in such a manner providing ready access for use
and placement as an artificial reef, unless a valid cargo manifest issued by the commission or a
commission-certified inspector is onboard the transporting vessel. The manifest will serve as authorization
to use a valid permitted site or land-based staging area, which will validate that the type of artificial reef
construction material being transported is permissible for use at the permitted site, and will describe and
quantify the artificial reef material being transported. The manifest will also include the latitude and
longitude coordinates of the proposed deployment location, the valid permit number, and the copy off the
permit conditions for the permitted site. The manifest must be available for inspection by any authorized law
enforcement officer or commission employee.”
This requirement for a cargo manifest became part of the statutory revision of the artificial reef
program statute Section 379.249 Florida Statutes (F.S.), modified during the 2000 State of Florida
Legislature. The statutory language allows a “commission certified inspector” to complete and approve the
artificial reef materials cargo manifest. Therefore, we are providing the attached cargo manifest form to all
local coastal government artificial reef coordinators and eligible non-profit corporations who may physically
construct artificial reefs with the approval of the permit holders.
INSTRUCTIONS
A separate cargo manifest form is to be completed for each load to be transported offshore
(i.e., one manifest per voyage). The manifest is to list all, and only, the reef materials onboard.
The top of the form is to be filled out by the reef builder with his/her contact information and
the information about the proposed reef materials to be deployed written into the boxes. If several
materials are identical but have different tag numbers, please write “SAME” in the box for the other
materials. Also put “SAME” under additional coordinates if all materials are going to the same
deployment site.
The shaded portion of the form at the bottom is to be filled out by the materials inspector.
The cargo manifest must be completed by an entity representing the holder of the applicable
artificial reef permit to assure that all materials meet the requirements of the permit.
Completion of the artificial reef materials cargo manifest is required for all construction activities.
The requirement to complete this document is not intended to be an undue burden on entities
wishing to legally construct artificial reefs within permitted sites, but is a tool to assist law enforcement
personnel in preventing the illegal construction of artificial reefs without the knowledge of the permit holder
or in areas outside of legally permitted sites. It is intended to allow law enforcement staff to determine
whether or not a load of materials is legal under the permit conditions. Without a properly completed Cargo
Manifest Form on board, reef builders will be returned to port pursuant to Chapter 379.249 (6) (b). It is not
necessary to send a copy of the Cargo Manifest Form to the FWC artificial reef section in Tallahassee.
Documentation of the reef building activity should be maintained by the entity issuing the manifest in the
event of any FWC inquiries.
Reminder: the placement of all public artificial reefs in state or adjacent federal waters requires the
submittal of a Materials Placement Report to the FWC artificial reef program within 30 days of public reef
deployment in accordance with s. 379.249 F.S.
FLORIDA ARTIFICIAL REEF MATERIALS
PLACEMENT REPORT AND POST-DEPLOYMENT NOTIFICATION
To Be Completed For Each Deployment Location or Date of Deployment
County or
Municipality:_____________________________________ Date of Placement:_________________________
Grant No. FWC - ________________________________ U.S. Army Corps
(if applicable) Permit No.: _______________________________
Total project cost: $___________ (Funding Source(s) and Amount(s): FWC $____________ Local $ __________ Other $________)
Name of Permitted Location Name
Reef Site: ________________________________ for This Deployment:________________________
°
Latitude:_____ ______.___ ___ ___’ North Longitude:______ °_______.___ ___ ___’ West
Degrees minutes decimal minutes Degrees minutes decimal minutes
GPS Brand:__________________ GPS Model number:___________
Geographical Location: ______________ at __________degrees from ___________________________________
(nautical miles) (bearing) (reference inlet)
Water Depth:________ feet (minus) Max. Material Height: ________feet (equals) Actual Vertical Clearance: ______feet
TYPE AND AMOUNT OF MATERIAL DEPLOYED AT THE LOCATION DESCRIBED ABOVE:
(ATTACH A PHOTOGRAPH OF THE MATERIAL ON THE BARGE IMMEDIATELY PRIOR TO DEPLOYMENT)
Primary Type of Material:____________________________________________ Number of Pieces:__________
Dimensions:________________________________________________________________________________
Secondary Type of Material:_________________________________________ Number of Pieces:__________
Dimensions:________________________________________________________________________________
How was tonnage calculated?(Check all that apply, attach additional sheets if necessary): Before & after barge draft calculation
Known weight of individual pieces
TOTAL TONNAGE FOR THIS DEPLOYMENT: _______________________ Trucking receipts
I DO HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
Observer’s Name: _________________________________ Title: _________________________________
(PLEASE PRINT) (PLEASE PRINT)
Observer’s Signature: _______________________________ Date: __________________________________
Observer’s Remarks: __________________________________________________________________________
___________________________________________________________________________________________
I DO HEREBY CERTIFY THAT THE ABOVE INFORMATION COMPLIES WITH THE ABOVE REFERENCED PERMIT CONDITIONS
Permittee’s Staff Name: _________________________________ Title: __________________________________
(PLEASE PRINT) (PLEASE PRINT)
Permittee’s Staff Signature: ______________________________ Date: _________________________________
Local Tracking number ______________ FWC Tracking number _______________ Entered by _________ on _________
Rev. 4/23/2007 FWC initials date
SELF-CERTIFICATION STATEMENT OF COMPLIANCE
Permit Number: SAJ-2012-03221 (SP-SWA)
Permittee’s Name & Address (please print or type): __________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Telephone Number: ____________________________________________________________________
Location of the Work: __________________________________________________________________
_____________________________________________________________________________________
Date Work Started: __________________________ Date Work Completed: ______________________
Description of the Work (e.g. bank stabilization, residential or commercial filling, docks, dredging, etc.):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Acreage or Square Feet of Impacts to Waters of the United States: _______________________________
Describe Mitigation completed (if applicable): ______________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Describe any Deviations from the Permit (attach drawing(s) depicting the deviations):
_____________________________________________________________________________________
_____________________________________________________________________________________
I certify that all work, and mitigation (if applicable) was done in accordance with the limitations and
conditions as described in the permit. Any deviations as described above are depicted on the attached
drawing(s).
______________________________
Signature of Permittee
______________________________
Date
