Atch 14 Range Pass NAFB 0-74.doc
DOC document 98 KB Posted
- Attached to
- NELLIS AFB SABER Federal contract opportunity
- Solicitation number
- FA4861-11-R-A300
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SIMPLIFIED ACQUISITION OF BASE Solicitation FA4861-11-R-A300 ENGINEERING REQUIREMENTS (SABER) Nellis Attachment #14
99TH RANGE GROUP FACILITIES VISIT REQUEST/AUTHORIZATION
This form is subject to the Privacy Act of 1974 (see reverse)
| FROM: |
| (Name and Phone Number) |
| Organization: |
| TO: |
| 99th Range Squadron |
3770 Duffer Dr
Nellis AFB NV 89191-7001 Commercial Phone: (702) 652-3606
DSN 682-3606 FAX 682-3808
Name of Your Range Squadron Point of Contact
Tolicha Peak/Tonopah Ranges Only
| NAME (LAST, First, M.I.) |
| RANK |
| Job Title |
| SSAN |
| Clearance |
| Organization |
| Citizenship |
| DOB |
| Place of Birth |
NAFB Form 0-74 Feb 96 (Electronically Generated)
| Mode of Transportation: |
| Entry/Exit Location |
| Date of Visit |
| FROM: |
| TO: |
| Areas to be Visited: |
| Check all that apply |
| Tonopah Area 10 |
Communications Sites:
Tonopah EC East
| Range Control Center: |
| Ranges: |
| 71N |
74C
Tonopah EC West
Building 200
64N
71S
75W
Tonopah Cactus EC
Other:
Red Forces
64S
74A
75E
Tolicha Peak ECR
Blackjack
66S
74B
Tolicha Peak EC South
Purpose of Visit in Detail:
| Naturalization Information: |
| Required for all naturalized citizens needing access to Tolicha Peak/Tonopah Ranges |
| Naturalization Number: |
| Place of Naturalization and Date: |
| Typed Name, Grade and Title of Requesting Official: |
| Duty Phone: |
Date:
| Coordination: |
| 99 RANS Security Manger |
Department of Energy
99 RANS/Det 1
Other
99 RANS/Det 2 (All Tonopah and Tolicha Peak Coordination)
Other
Bldg 200 Security
Other
99 RANS/CC/DO
Other
APPROVED FOR ACCESS
APPROVED FOR ACCESS WITH ESCORT LISTED BELOW
DISAPPROVED
| Typed Name, Grade, and Title of Approval Authority: |
| Signature: |
| Date Submitted: |
| Suspense Date: |
Remarks:
PRIVACY ACT STATEMENT
| AUTHORITY: |
| 10 USC 8013 |
| PRINCIPAL PURPOSE: |
| For positive identification for entry into United States Air Force restricted and |
| ROUTINE USES: |
| None |
| DISCLOSURE IS VOLUNTARY: |
| Furnishing this information is voluntary. If you do not give the required information, you will not be allowed entry into these areas. |
NAFB Form 0-74 Feb 96 (Back) (Electronically Generated)
Atch 6, Page 2 of 2
File details come from the government source that posted it. Updated .