2. Oak Harbor Marina

   Live Aboard Pump-out Monthly Log

4. Month
5. Marina Account #*
7. Tenant Full Name
9. Slip #*
10. Telephone #
11. Holding Tank Size*

13. I hereby certify that I have used Oak Harbor Marina pump-out equipment or a pump-out service to properly dispose of boat sewage from my vessel as required in my Authorization to Live Aboard agreement. Dates and times that I pumped out my holding tank are listed below 

15. DATE
16. TIME
17. METHOD*
    -- Select One --FUEL DOCKCADDY
18. APPROX. GALLONS*
20. DATE
21. TIME
22. METHOD
    -- Select One --FUEL DOCKCADDY
23. APPROX. GALLONS
25. DATE
26. TIME
27. METHOD
    -- Select One --FUEL DOCKCADDY
28. APPROX. GALLONS
30. DATE
31. TIME
32. METHOD
    -- Select One --FUEL DOCKCADDY
33. APPROX. GALLONS
35. DATE
36. TIME
37. METHOD
    -- Select One --FUEL DOCKCADDY
38. APPROX. GALLONS
40. MONTHLY TOTAL*

    TOTAL GALLONS

42. Please submit the pump-out log to the marina office by the 5th of each month. Failure to submit this pump-out log by 4:30pm on 5th of each month may result in the termination of liveaboard status. 

44. COMMENTS/REMARKS
46. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
48. Electronic Signature
50. DATE/TIME*
    DATE/TIME

    DATE/TIME
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

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