Att J-0200000-05 RA Badge.pdf

PDF 86 KB Posted

Attached to
Naval Weapons Station Earle Environmental Laboratory Services Federal contract opportunity
Solicitation number
N4008526R0013
Issued by
Department of the Navy Naval Facilities Engineering Command

About this file

Written by GovTribe AI ·

This document is a Restricted Area Access Request Form for Naval Weapons Station (NWS) Earle, revision 7-2024. The form is designed for contractors and subcontractors requiring access to restricted areas, including Ordnance, Pier, C-33, and C-34 zones. Applicants must provide comprehensive personal information such as name, address, contact details, CAC or driver's license number, and the last 4 digits of their social security number. The form requires processing time of 5 business days and includes sections for government representatives to approve access, verify clearance status, and issue a pass/badge. The document is marked as Controlled Unclassified Information (CUI) and is controlled by the Department of the Navy, with privacy act protections in place.

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N4008526R0013 Questions and Answers.pdf PDF
Attachment 003 1800000 C Environmental.pdf PDF
Attachment 006 1800000 FAP Envirionmental.pdf PDF
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Attachment 001 0100000 C General Information.pdf PDF
Attachment 004 0200000 F Management and Administration.pdf PDF
Attachment 007 1800000 WBS Environmmental.pdf PDF
Att J-1800000-03 Current Sludge Testing.pdf PDF
Att J-1800000-04 Current Sewer Treatment Plant Testing.pdf PDF
Att J-1800000-05 Proposed Sewer Treatment Plant Testing.pdf PDF
Att J-1800000-09 Waste Water Testing Requirements.pdf PDF
Att J-1800000-10 Potable Water Testing Requirements.pdf PDF
Att J-0200000-05 NAVFAC CSIR FORM W.pdf PDF
Attachment 002 0200000 C Management and Administration.pdf PDF
Attachment 008 1800000 M Envirionmental.pdf PDF
Att J-1800000-01-02 Environmental.pdf PDF
Att J-0200000-05 5512 7-31-2027.pdf PDF
Solicitation - N4008526R0013.pdf PDF
Attachment 005 1800000 F Environmental.pdf PDF
Att J-1800000-07-08 Historical Data Sampling and Potential Rqrmts.pdf PDF
Att J-1800000-11 Per- and Polyfluorinated Alkyl Substances (PFAS) Sampling.pdf PDF
Att J-0200000 J Management and Administration.pdf PDF
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NWSEARLEINST 5530.12C

TAB R

CUI

RESTRICTED AREA ACCESS REQUEST FORM REVISION 7-2024

PLEASE ALLOW 5 BUSINESS DAYS FOR PROCESSING

APPLICANT INFORMATION

VCC Results:

CLEARED NOT CLEARED

Signature/Date

Pass/Badge Number Issued By (Print) Signature/Date

CUI

CONTROLLED BY: DEPARTMENT OF THE NAVY

CUI CATEGORY: PRVCY

DISTRIBUTION/DISSEMINATION CONTROL: FEDCON

POC: VISTOR CONTROL CENTER NWSE

Name:

Address:

City: State: Zip:

Phone Number: Date of Birth:

CAC or Driver’s license number: CAC Expiration:

Last 4 of Social Security number:

Prime Contractor Company Phone Number Sub Contractor Name Phone Number

Contract Expiration Date:

(Last) (First) (Middle)

***PRIVACY ACT OF 1974 APPLIES*** (SEE NOTE BELOW)

GOVERNMENT REPRESENTATIVE ONLY

RESTRICTED AREA ACCESS APPROVAL

CAMERA

Security Representative Signature and Date

ORDNANCE PIER C-33 C-34

1. It is requested that a badge/pass be issued to the person listed above. It is understood that this command/company will be responsible for said pass and it will be returned as the termination of assignment/employment or completion of present contract.

2. It is further represented that this command/company assumes responsibility for the person listed above while they are on the property of Naval Weapons Station (NWS) Earle during the period for which the badge/pass will be issued.

Government Representative (Print) Phone Number Signature/Date

Slide 1

Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zipcode:
Phone:
Date of Birth:
CAC or DL#:
CAC Exp:
Last 4 SSN:
Prime Contractor:
Prime Phone:
Sub Phone:
Contract Exp:
Camera: Off
Ordnance: Off
Pier: Off
C33: Off
C34: Off
Sponsor:
Sponsor Phone:
Cleared: Off
Not Cleared: Off
Pass/Badge #:
Issuer:
Clear Form:

File details come from the government source that posted it. Updated .