visit request N Range Gravel.docx

UTAH TEST AND TRAINING RANGE (UTTR) VISIT REQUEST

This form is subject to the Privacy Act of 1974. Authority: Executive Orders 9397; 9838; 10450; and 11652; 10 U.S.C. 8013 Secretary of the Air Force. System of records notice F205 AFSCO C. Purpose: This form is to used to validate clearances, verify need-to-know, and ensure safety of visitors to the UTTR. Routine Uses: Information provided will not be released without the written consent of provider. Disclosure: Voluntary. Failure to provide requested information could delay or prevent access.

TO: 388RANS/SF Commercial Phone: (801) 777-2313 5948 Southgate Avenue DSN: 777-2313 Hill Air Force Base, UT 84056-5232 FAX: 775-4226 E-Mail Address: ed.Dimmock@hill.af.mil FROM (Organization, address, phone number):

1. Visit approval is requested for the personnel listed below. Visit will be considered approved unless otherwise notified.

(Contractors Only)

2. Area(s) to be Visited (check all that apply):

|_| Bldg 1274 (MCC) |_| Bldg 1A |_| Bldg 1 (DUF) |_| Dugway & UTTR South Range |X| Oasis, Eagle & UTTR North Range |_| Other:

3. Purpose of Visit: (Note: Safety Briefings And Radios With Call Signs Are Required Prior To Accessing The North or South Range) Site visit to DK pit on North Range for gravel crushing contract.

4. Date(s) of Visit 9/15/2011

5. Name(s) of Person(s) to be Visited Kathy Vaux

6. Name & Grade of Certifying Security Official

7. Certifying Official Signature/Date

388RANS USE

Name, Grade, and Title of Approving Authority:

Approving Authority Signature/Date

POC for radios on R6402, R6406, and R6407 is 388RANS at Dugway, Commercial (435) 522-5343, or DSN 789-5343 POC for radios on R6404 is 75RANS at Oasis, Commercial (801) 777-1522 or DSN 777-1522 Call Sign(s):

Remarks: Do not e-mail completed form outside the Hill AFB firewall, fax the completed signed form to the fax number listed above Request Are For Event Date(s) Only, One Year Request Will Not Be Approved

388RANS FORM 0-17, MARCH 1999