Attachment 2 - Site Visit DLA Form 1818.pdf

DLA Form PDF 94 KB Posted

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Replacement of Boiler Oxygen Monitoring and Control Systems for DDSP - CSS SP3300-25-Q-0226
Solicitation number
SP3300-25-Q-0226
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PRIVACY ACT STATEMENT

VISIT NOTIFICATION

1. ACTIVITY TO BE VISITED

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:DEFENSE LOGISTICS AGENCY

8725 JOHN J. KINGMAN ROAD

FT BELVOIR, VA 22060-6220

Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.

To control access to and movement on DoD installations, buildings, or facilities.

Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.

Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.

DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES

SECTION I

2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE

5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE

8. PURPOSE OF VISIT

SECTION II

9.

NAME(S) OF VISITOR(S)

(Last, First, MI)

10.

GRADE/RANK

11.

SSN

12.

DATE OF BIRTH

13.

STATE /COUNTRY OF

BIRTH

14.

CLEARANCE/DATE

GRANTED

15.

TYPE OF INVESTIGATION/

DATE

16. TYPED NAME OF SECURITY REPRESENTATIVE

SECTION III

18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE

DLA FORM 1818, JUL 96 (EG)

FROM: TO:

PDF (DLA)

RequesterName: Christopher Chapman
OfficeCode: DDSP
FacPOC: Christopher Chapman
Phone: 717-770-4119
POCPhone: 717-770-4119
VisitedActivity: DLA Installation Management at Susquehanna,

Building 753 VisitPurpose: Site Visit of Building 753 for potential vendors interested in quoting boiler repair/replacement requirements.

Visitor has registered utilizing the pre-enrollment website: https://dbids-global.dmdc.mil

DateTo: 2 Jan 23
Visitor:
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