21B0405C-1.pdf

PDF 316 KB Posted Jan 19, 2021

Attached to: INTEGRATED SOLID WASTE MANAGEMENT SERVICES
Solicitation number: N40084-21-B-0405
Issued by: Department of the Navy Naval Facilities Engineering Command

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21B0405C-2.pdf	PDF	Jan 19, 2021
21B0405B.pdf	PDF	Jan 19, 2021
21B0405A.pdf	PDF	Jan 19, 2021

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REQUEST FOR FUEL TERMINAL ACCESS HAKOZAKI TSURUMI

REQUEST MUST BE SUBMITTED TO FACP AT HAKOZAKI OR TSURUMI 72 HOURS PRIOR TO YOUR VISIT!

この申請書は箱崎もしくは鶴見の警備隊宛に入門の 72 時間前に提出されなければなりません。

FACP FORM 5531/3 EJ (20070410)(EF)

Date (日付) From:

会社名

To: Hakozaki/Tsurumi Fuel Terminal Supervisor, Fleet Logistics Center Yokosuka

Via Industrial Security Office, Fleet Activities, Yokosuka (FAY) Subj: REQUEST FOR BASE ACCESS (HAKOZAKI TSURUMI ) Ref: (a) FISCINST 5330.7B//(b) COMFLEACTINST 5530.3//(c) USFJINST 31-204

1. It is requested that the visitor listed on the back page be authorized access to HAKOZAKI /TSURUMI 箱崎 / 鶴見地区への立ち入許可申請を御願いします。

DATE/TIME 日時

Purpose for Visit 訪問の目的 Date 訪問日 Destination 訪問先 Time (From) 入門時間 Time (To) 出門時間

POINT OF CONTACT 連絡先

Name (Last) 氏 / フリガナ Name (First) 名 / フリガナ Tel: 電話番号:

E-mail Address （可能であれば）

Signature （サイン）

Date: ___________

FIRST ENDORSEMENT

From: Industrial Security Officer, FAY To: Hakozaki/Tsurumi Fuel Terminal Facility Supervisor, FLCY

1. All names have been screened.

Signature

SECOND ENDORSEMENT

From: Hakozaki/Tsurumi Fuel Terminal Facility Supervisor, FLCY To __________________________________________________________

1. Your request is approved. The Fleet Activities Civil Police will issue a gate pass to your employees after verifying their ID card.

入門を許可します。警備隊により身分証明の確認を受けた後、バッチを受け取って下さい。

Signature

CUI//FEDCON

REQUEST FOR FUEL TERMINAL ACCESS HAKOZAKI TSURUMI

氏名 (漢字) 生年月日国籍現住所

フリガナ

身分証明書として認められている書類 (Proper Identification forms) ＊日本人(Japanese)：運転免許証（本籍入り）(Driver's License with Permanent Address)、パスポート

(Passport)、住民基本台帳（写真入り）(Resident Card with Picture) のいずれか＊外国人(Non Japanese)：パスポート(Passport)、或いは外人登録書 (Alien Registration Card)

年月日

登録番号下4桁車名形式色車検期限自賠責期限入門パス有効期限ドライバー

Request for Fuel Terminal Access / Hakozaki □ Tsurumi □

CUI//FEDCON

Toshiki.Hisasue.JA Rectangle

year:

day:

month:

Check Box1: Yes

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File details come from the government source that posted it. Updated Jan 19, 2021.