Coast Guard Activities Europe Life Raft Servicing Request

Station:   (i.e. Liferaft Service, Inc)

Your Name:

Station # (i.e.145)                         

Your E-mail:

                     Station Location:

 Your Phone:

                                                                                                                                                                                                    Special Tests Due:

                                                                                                                                                                                                            (Yes/No)

Make

(i.e. "Viking")

Size

(# of Persons i.e. "25")

Type Serial No. Date of Mfr

(i.e. 8/2002)

Age

(In Years)

Gas Inflation

 

Floor Seam NapTest Davit Load Hydro Test Ship Owner