Report Form

Within the 30 days the following information must be included in the report sent to EPA:

Burial at Sea Report Form
Name of Deceased:
Date of Burial/Scatter:
Types of Remains:	Cremated Non-Cremated
Date of Cremation (If Applicable):
Location of Burial/Scatter:
Latitude
Longitude
Distance from shore (min. of 3 nm)
Depth of water
Vessel Name:
Vessel Point Of Contact: (name and phone number)
Port of Departure:
For Non-Cremated Remains: Did the remains appear to rapidly sink to the ocean floor	Yes No
Name/Phone # of Director/Person(s) Responsible for Burial Arrangements:
**Please Send Photocopies of Burial, Cremation or Other Permits Required by Appropriate Civil Authorities in an Email to Ann Rodney (rodney.ann@epa.gov). Please List Name of Deceased in the Subject Line.

OR please send the same information to:

Ann Rodney (rodney.ann@epa.gov)
Burial at Sea Coordinator
US EPA Region 1
1 Congress St.
Boston, MA 02114-2023
(617) 918-1538