Atch 4_Escort Request Form_ Entry-Exit.pdf

PDF 1 MB Posted Jun 4, 2025

Attached to: Integrated Solid Waste Management Services at U. S. Marine Corps Air Station Iwakuni, Japan
Solicitation number: N4008425B0003
Issued by: Department of the Navy Naval Facilities Engineering Command

About this file

Written by GovTribe AI · Jun 4, 2025

This document is a 1-Day Official Entry/Exit Request form (Appendix H MCASO 5500.2V) used for site visit access to the U.S. Marine Corps Air Station Iwakuni, Japan, in connection with the Integrated Solid Waste Management Services solicitation. The form requires detailed information about guests, including full name, nationality, passport number, date of birth, address, and place of work, and stipulates that guests must be escorted at all times, check in at the main gate with a valid picture ID, and adhere to specific facility access policies. Key requirements include submitting the form to PMO Admin during working hours 3 business days in advance, ensuring guests have proper identification, and understanding that violations may result in disciplinary action up to termination of sponsorship privileges.

The form is part of the solicitation (N4008425B0003) for waste management services at MCAS Iwakuni, with a site visit scheduled for 17 Jun 2025 at 1:30 PM. Interested bidders must notify the Point of Contact (Ms. Masayo Inoue or Ms. Youko Abe) by 9 Jun 2025 at 11:00 AM if they need an escort, and must submit this entry/exit request form by the same deadline. The document emphasizes privacy and security, with a Privacy Act Data Cover Sheet indicating that the enclosed documents contain personal information subject to the Privacy Act of 1974 and should not be disclosed without proper authorization.

View the file

Other files

File	Type	Posted
Amend 0001_Atch(1)_Govt Response.pdf	PDF	Jul 1, 2025
N4008425B00030001_Amend0001.pdf	PDF	Jul 1, 2025
Amend 0001_Atch(2)_Amendment_lis.pdf	PDF	Jul 1, 2025
Atch 3_ RepresentationsR.pdf	PDF	Jun 4, 2025
SF 1449 - N4008425B0003.pdf	PDF	Jun 4, 2025
Atch 2_0200000_09_ELINS_ISWM_250328.xlsx	XLSX spreadsheet	Jun 4, 2025
Atch 5_Pre-Award Inguirty Form.xlsx	XLSX spreadsheet	Jun 4, 2025

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

THIS FORM SHALL BE SUBMITTED WITH COMPLETED 1-DAY OFFICIAL ENTRY/EXIT REQUEST

Name of Escorter : Grade: DoD ID#

Name of Sponsor : Grade: DoD ID#

Organization : TEL# RTD:

MM/YY

Destination: From: To:

Time / Date Time / Date

Purpose of Request:

**日本語で記入する場合、名前及び国籍は英語表記でも記入すること / You can fill out all in Japanese except guests name and nationality.

**17歳以下で親の同伴がない場合は承諾書が必要/ Children 17 years old or younger traveling without their parents need to attach signed “Permission Statement”

H-1

3) Facility access is contingent upon MCX and DECA policy and should be addressed with each facility directly.

4) Those guest(s) who attend club activities must check out and exit the Air Station within 30 minutes of respective club's closing.

5) A violation of this authorization may result in disciplinary action up to termination of sponsorship privilages.

Work / Cell Phone

ADDRESS, TEL#

(住所、電話番号)

PLACE OF

WORK

"For Official Use Only - Privacy Sensitive : Any misure or unauthorized disclosure may result in both civil and criminal penalties"

Approving Official

PRINT NAME

Sponsor's Signature

1) GUEST(S) MUST BE ESCORTED AT ALL TIMES WHILE ON THE INSTALLATION. PASS(ES) MUST BE RETURNED TO THE MAIN GATE SENTRY WHEN

YOUR GUEST(S) EXIT THE AIR STATION.

2) Your respective guest(s) must check in upon entering the Air Station and be issued a visitor's pass. A Vailed picture

I.D. is requred at Main Gate when checking in.

DOB(生年月日)DD/MM/YY,AGE (歳)

BADGE#

APPENDIX H MCASO 5500.2V

1-DAY OFFICIAL ENTRY/EXIT REQUEST Date:______________ (Must Submit to PMO Admin DURING WORKING HOURS 3 BUSINESS DAYS IN ADVANCE)

NATIONALITY

PASSPORT#

VEH#

PRINT NAME OF GUEST（氏名）

QTRS#

REVISION Ver.1(14Jan2016)

Name of Escorter : Grade: DoD ID#

Name of Sponsor : Grade: DoD ID#

Organization : TEL# RTD:

MM/YY

Destination: From: To:

Time / Date Time / Date

Purpose of Request:

** / You can fill out all in Japanese except guests name and nationality.

**17 / Children 17 years old or younger traveling without their parents need to attach signed “Permission Statement”

H-1

3) Facility access is contingent upon MCX and DECA policy and should be addressed with each facility directly.

4) Those guest(s) who attend club activities must check out and exit the Air Station within 30 minutes of respective club's closing.

5) A violation of this authorization may result in disciplinary action up to termination of sponsorship privilages.

Work / Cell Phone

ADDRESS, TEL#

PLACE OF

WORK

"For Official Use Only - Privacy Sensitive : Any misure or unauthorized disclosure may result in both civil and criminal penalties"

Approving Official

PRINT NAME

Sponsor's Signature

1) GUEST(S) MUST BE ESCORTED AT ALL TIMES WHILE ON THE INSTALLATION. PASS(ES) MUST BE RETURNED TO THE MAIN GATE SENTRY WHEN

YOUR GUEST(S) EXIT THE AIR STATION.

2) Your respective guest(s) must check in upon entering the Air Station and be issued a visitor's pass. A Vailed picture I.D. is requred at Main Gate when checking in.

DOB( )DD/MM/YY,AGE ( )

BADGE#

APPENDIX H MCASO 5500.2V

1-DAY OFFICIAL ENTRY/EXIT REQUEST Date:______________ (Must Submit to PMO Admin DURING WORKING HOURS 3 BUSINESS DAYS IN ADVANCE)

NATIONALITY

PASSPORT#

VEH#

PRINT NAME OF GUEST

QTRS#

REVISION Ver.1(14Jan2016)

Sample

Sample Sample Sample Sample Sample Sample Sample

Sample Sample Sample Sample

Sample Sample Sample Sample Sample

Sample

Taro IWAKUNI 岩国太郎 25/04/80, 39

Japanese Passport# xxxxxxx

1-2-3, Iwakuni, Yamaguchi, Japan 0827-79-xxxx

ABC

Corporation

Yamaguchi

400 WA 12-34

SAMPLE

ID type (passport or driver's license) and its number

Valid Picture ID:

"Passport (original)" or "Driver's License WITH original Jyumin Hyo with permanent address (Honseki-chi)"

Leave Blank Leave Blank

Leave Blank youko.abe.ja Highlight youko.abe.ja Highlight youko.abe.ja Polygon youko.abe.ja Polygon

QTRS:

Organization:

RTD:

Destination:

Purpose of Request: Site visit for Integrated Solid Waste Management Services at U. S. Marine Corps Air Station Iwakuni, Japan

PLACE OF WORKRow1:

BADGERow1:

2_2:

PLACE OF WORKRow2:

VEHRow2:

BADGERow2:

3_2:

PLACE OF WORKRow3:

VEHRow3:

BADGERow3:

4_2:

PLACE OF WORKRow4:

VEHRow4:

BADGERow4:

5_2:

PLACE OF WORKRow5:

VEHRow5:

BADGERow5:

6_2:

PLACE OF WORKRow6:

VEHRow6:

BADGERow6:

7_2:

PLACE OF WORKRow7:

VEHRow7:

BADGERow7:

8_2:

PLACE OF WORKRow8:

VEHRow8:

BADGERow8:

9_2:

PLACE OF WORKRow9:

VEHRow9:

BADGERow9:

10:

10_2:

PLACE OF WORKRow10:

VEHRow10:

BADGERow10:

PRINT NAME:

REQUEST Date:

escorter:

escorter Grade:

escorter DoD ID:

Sponsor name:

Sponsor Grade:

Sponsor DoD ID:

TEL:

cell:

From time:

From day:

To time:

To date:

vehicle:

nationality 1:

passport 1:

nationality 2:

passport 2:

nationality 3:

passport 3:

nationality 4:

passport 4:

nationality 5:

passport 5:

nationality 6:

passport 6:

nationality 7:

passport 7:

nationality 8:

passport 8:

nationality 9:

passport 9:

nationality 10:

passport 10:

add1:

add1-2:

add2:

add2-1:

add3:

add3-1:

add4:

add4-1:

add5:

add5-1:

add6:

add6-1:

add7:

add7-1:

add8:

add8-1:

add9:

add9-1:

add10:

add10-1:

1_2:

age 1:

age 2:

age 3:

age 4:

age 5:

age 6:

age 7:

age 8:

age 9:

age 10:

File details come from the government source that posted it. Updated Jun 4, 2025.