Site_Visit_Pass_Sheet.doc

FA466419BA004

SITE VISIT - PASS INFORMATION SHEET

NAME OF COMPANY:

DATE SHEET SUBMITTED:

PHONE NUMBER:

DATE VISITING MARCH ARB: 17 July 2019

TIME: 0800 - 1100

SPONSOR NAME: Martha O’Donnell

SPONSOR PHONE #:951-655-5761

Norman MacRunnel

951-655-5758

DRIVER’S

NAME

SSAN

LICENSE

DOB

Ensure individuals bring the following items to Pass and Registration; (1) Driver’s License, (2) Registration and (3) Proof of insurance

CONTRACTING OFFICE ENDORSEMENT

DATE

Privacy Act Statement

PRIVACY ACT-1974 as Amended applies – This memo may contain information which must be protected IAW DOD 5400-11, and it is For Official Use Only (FOUO)

AUTHORITY: 10 U.S.C. 8013; 44 U.S.C. 3101; and EO 93397

PRINCIPAL PURPOSES: Used to record information and details of criminal activity which may require investigative action by commanders, supervisors, police, special agents, etc. ROUTINE USES: Information may be disclosed to Pass and Registration to determine base access. DISCLOSURE IS VOLUNTARY: SSN is used to positively identify the individual as a conduit to check past criminal activity records. Failure to provide the request information will affect your ability to gain access to March Air Reserve Base, CA.