PWS Attachment C - PACAF Regional Support Center Site Arrival Request (SAR).pdf

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Attached to
Solicitation: Full and Open CLS Sustainment services for the AEWS AN/FPS-117 Radar System
Solicitation number
FA821725RB004
Issued by

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The document is a PACAF Regional Support Center Site Arrival Request form, which is an administrative document used to request and track site access, travel, and support for personnel arriving at a military facility. The two-page form requires detailed information including traveler details, travel logistics, aircraft information, support requirements, and restricted area access. Key sections include aircraft pre-arrival processing (PPR) information, support needed (such as transportation, equipment, vehicles), restricted area access, firearm details, and traveler information with spaces for up to 20 individuals. The form is marked as Controlled Unclassified Information/Personal-Identifiable Information and is version dated January 2024, with instructions indicating that older versions are obsolete. The form is to be used by the 611th Air Support Squadron's Mission Support Flight for Site Arrival Operations, with contact numbers provided for DSN and commercial communication.

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PACAF REGIONAL SUPPORT CENTER SITE ARRIVAL REQUEST

CONTROLLED UNCLASSIFIED INFORMATION/PERSONAL-IDENTIFIABLE INFORMATION DOCUMENT WHEN COMPLETED

NAME:

ADDRESS:

PHONE:

EMAIL:

3. TRAVEL:

A. LOCATION:

B. DATE/TIME ARRIVAL:

C. DATE/TIME DEPARTURE:

ARR/DEP COMMENTS:

D. PURPOSE:

E. MEANS OF TRAVEL: C-12 AMC CHARTER MIL-AIR OTHER SPECIFY:

4. AIRCRAFT PPR INFORMATION:

A. AIRCRAFT TYPE: B. CALL SIGN: C. TAIL NUMBER: D. DATE/TIME ARR. (Z): E. DATE/TIME DEP. (Z):

F. DEP LOCATION: G. DESTINATION: H. HANGAR J. TOWBAR J. HAZ TYPE:

K. GPU L. FUEL (J-8) AMOUNT: M. IN-FLIGHT MEALS QUANTITY:

5. SUPPORT REQUIRED:

A. 3RD PARTY SUPPORT HOURS: B. TRANSPORTATION TO/FROM PORT C. PERMIT: SELECT OR ENTER PERMIT TYPE:

D. EQUIP: TYPE: E. SUPPLIES: TYPE: F. VEHICLE: DOD: CTR: QTY: TYPE:

G. NON-AIRCRAFT FUEL: DIESEL AMOUNT: MO-GAS AMOUNT: H. RADAR DOWNTIME:

J. RESTRICTED AREA ACCESS: MET IDT COBRA DANE POWER PLANT TER MAR TOWER CLASSIFIED ACCESS:

I. FIREARM(S): QTY:

MAKE: TYPE: SERIAL #: CALIBER: # OF RDS:

YES NO DEVICE MAKE AND MODEL: DEVICE SERIAL #

LOCATION (S):

K. INSTALLLATION PHOTOGRAPHY:

CONTENT:

L. OTHER SUPPORT:

1. REQUESTOR:

A. FIRST AND LAST NAME: B. PHONE NUMBER: DSN COMM

C. EMAIL: D. ORGANIZATION: E. SITE POC:

2. FINANCE: BILLING POC:

A. WAKE ISLAND TRAVELER(S) B. EARECKSON AIR STATION TRAVELER(S) C. KING SALMON TRAVELER(S)

D. ALL NON- PACAF REGIONAL SUPPORT CENTER (PRSC) TRAVELER(S) E. PRSC TRAVELER(S) ONLY

Base PASS REQ: YES NO

F.

SUPPORT AGENCY

REMOVABLE MEDIA: DEVICE MAKE AND MODEL: DEVICE SERIAL #:

COMPLETE ATTACHED DD FORM 2760 & AF FORM 1314 & ADD ADDITIONAL WEAPONS IN BLOCK 6.

7. TRAVELER INFORMATION:

# LAST NAME, FIRST NAME, MI RESTRICTED ACCESS RANK SEX DOB: ORGANIZATION SSN # DOD ID/DL# DL STATE CLEARANCE

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

6. ADDITIONAL INFORMATION: (PM/SAR ADMIN ONLY) CHARGE TRAVELERS FOR: MEALS LODGING MAN DAYS

Approval Authority: COPA # Approved By: 611th AIR SUPPORT SQUADRON Mission Support Flight Site Arrival Operations

DSN: 317-552-5781

COMM: 907-552-5781

COPA INSTRUCTIONS:

FORM VERSION JAN 2024 OLDER VERSIONS ARE OBSOLETE

CONTROLLED UNCLASSIFIED INFORMATION/PERSONAL-IDENTIFIABLE INFORMATION DOCUMENT WHEN COMPLETED

EX. 20240815

Untitled
Untitled
F SITE POC:
A WAKE ISLAND TRAVELERS B EARECKSON AIR STATION TRAVELERS C KING SALMON TRAVELERS D ALL NONPACAF REGIONAL SUPPORT CENTER PRSC TRAVELERS E PRSC TRAVELERS ONLYRow1:
NAME ADDRESS PHONE EMAIL:
B DATETIME ARRIVAL:
C DATETIME DEPARTURE:
D PURPOSE:
A AIRCRAFT TYPE:
B CALL SIGN:
C TAIL NUMBER:
D DATETIME ARR Z:
E DATETIME DEP Z:
F DEP LOCATION:
G DESTINATION:
H HANGAR J TOWBAR J HAZ TYPE:
K INSTALLLATION PHOTOGRAPHY YES NO DEVICE MAKE AND MODEL DEVICE SERIAL CONTENT LOCATION S L OTHER SUPPORT:
PMSAR ADMIN ONLY CHARGE TRAVELERS FOR MEALS:
LAST NAME FIRST NAME MI1:
SEX1:
ORGANIZATION1:
SSN 1:
DOD IDDL1:
DL STATE1:
LAST NAME FIRST NAME MI2:
SEX2:
ORGANIZATION2:
SSN 2:
DOD IDDL2:
DL STATE2:
LAST NAME FIRST NAME MI3:
SEX3:
ORGANIZATION3:
SSN 3:
DOD IDDL3:
DL STATE3:
LAST NAME FIRST NAME MI4:
SEX4:
ORGANIZATION4:
SSN 4:
DOD IDDL4:
DL STATE4:
LAST NAME FIRST NAME MI5:
SEX5:
ORGANIZATION5:
SSN 5:
DOD IDDL5:
DL STATE5:
LAST NAME FIRST NAME MI6:
SEX6:
ORGANIZATION6:
SSN 6:
DOD IDDL6:
DL STATE6:
LAST NAME FIRST NAME MI7:
SEX7:
ORGANIZATION7:
SSN 7:
DOD IDDL7:
DL STATE7:
LAST NAME FIRST NAME MI8:
SEX8:
ORGANIZATION8:
SSN 8:
DOD IDDL8:
DL STATE8:
LAST NAME FIRST NAME MI9:
SEX9:
ORGANIZATION9:
SSN 9:
DOD IDDL9:
DL STATE9:
LAST NAME FIRST NAME MI10:
SEX10:
ORGANIZATION10:
SSN 10:
DOD IDDL10:
DL STATE10:
LAST NAME FIRST NAME MI11:
SEX11:
ORGANIZATION11:
SSN 11:
DOD IDDL11:
DL STATE11:
LAST NAME FIRST NAME MI12:
SEX12:
ORGANIZATION12:
SSN 12:
DOD IDDL12:
DL STATE12:
LAST NAME FIRST NAME MI13:
SEX13:
ORGANIZATION13:
SSN 13:
DOD IDDL13:
DL STATE13:
LAST NAME FIRST NAME MI14:
SEX14:
ORGANIZATION14:
SSN 14:
DOD IDDL14:
DL STATE14:
LAST NAME FIRST NAME MI15:
SEX15:
ORGANIZATION15:
SSN 15:
DOD IDDL15:
DL STATE15:
LAST NAME FIRST NAME MI16:
SEX16:
ORGANIZATION16:
SSN 16:
DOD IDDL16:
DL STATE16:
LAST NAME FIRST NAME MI17:
SEX17:
ORGANIZATION17:
SSN 17:
DOD IDDL17:
DL STATE17:
LAST NAME FIRST NAME MI18:
SEX18:
ORGANIZATION18:
SSN 18:
DOD IDDL18:
DL STATE18:
LAST NAME FIRST NAME MI19:
SEX19:
ORGANIZATION19:
SSN 19:
DOD IDDL19:
DL STATE19:
LAST NAME FIRST NAME MI20:
SEX20:
ORGANIZATION20:
SSN 20:
DOD IDDL20:
DL STATE20:
A FIRST AND LAST NAME:
C EMAIL:
ORG:
DSN: Off
COMM: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off
Check Box8: Off
Check Box9: Off
PAYMENT: [MIPR/FUNDING DOCUMENT NUMBER]
PHONE NUMBER:
AGENCY:
YES: Off
NO: Off
LOCATION: [ ]
ARR/DEP COMMENTS:
C12: Off
AMC: Off
CHARTER: Off
MIL AIR: Off
GPU: Off
FUEL: Off
Check Box26: Off
Text27:
Text28:
Check Box29: Off
Text30:
Check Box31: Off
Check Box32: Off
Check Box33: Off
SUPT: Off
Text35:
TO/FROM: Off
Check Box37: Off
Text38:
EQUIP: Off
Text40:
SUPPLIES: Off
Text42:
Check Box43: Off
Check Box44: Off
Text46:
Check Box47: Off
Text50:
Check Box51: Off
Text53:
Check Box54: Off
Text56:
Check Box58: Off
Check Box59: Off
Check Box60: Off
Check Box61: Off
Check Box62: Off
Check Box64: Off
Check Box65: Off
Check Box66: Off
Text67:
Text68:
Text69:
Text70:
Check Box71: Off
Check Box72: Off
Check Box73: Off
Text45:
Text76:
Text77:
Text81:
CARRIER NAME:
GPU1: [N/A]
Check Box2: Off
Check Box3: Off
RESET:
REMOVE PII:
CLEARANCE1: [NONE]
CLEARANCE2: [NONE]
CLEARANCE3: [NONE]
CLEARANCE4: [NONE]
CLEARANCE5: [NONE]
CLEARANCE6: [NONE]
CLEARANCE7: [NONE]
CLEARANCE8: [NONE]
CLEARANCE9: [NONE]
CLEARANCE10: [NONE]
CLEARANCE11: [NONE]
CLEARANCE12: [NONE]
CLEARANCE14: [NONE]
CLEARANCE13: [NONE]
CLEARANCE15: [NONE]
CLEARANCE16: [NONE]
CLEARANCE17: [NONE]
CLEARANCE18: [NONE]
CLEARANCE19: [NONE]
CLEARANCE20: [NONE]
RANK20: [CTR]
RANK19: [CTR]
RANK18: [CTR]
RANK17: [CTR]
RANK16: [CTR]
RANK15: [CTR]
RANK14: [CTR]
RANK13: [CTR]
RANK12: [CTR]
RANK11: [CTR]
RANK10: [CTR]
RANK9: [CTR]
RANK8: [CTR]
RANK7: [CTR]
RANK6: [CTR]
RANK5: [CTR]
RANK3: [CTR]
RANK4: [CTR]
RANK2: [CTR]
RANK1: [CTR]
DATE1:
DATE2:
DATE3:
DATE4:
DATE5:
DATE6:
DATE7:
DATE8:
DATE9:
DATE10:
DATE11:
DATE12:
DATE13:
DATE14:
DATE15:
DATE16:
DATE17:
DATE18:
DATE19:
DATE20:
weapon type: [N/A]
RESTRICTED ACCES1: [UNESCORTED]
RESTRICTED ACCES2: [UNESCORTED]
RESTRICTED ACCES3: [UNESCORTED]
RESTRICTED ACCES4: [UNESCORTED]
RESTRICTED ACCES6: [UNESCORTED]
RESTRICTED ACCES5: [UNESCORTED]
RESTRICTED ACCES7: [UNESCORTED]
RESTRICTED ACCES8: [UNESCORTED]
RESTRICTED ACCES9: [UNESCORTED]
RESTRICTED ACCES10: [UNESCORTED]
RESTRICTED ACCES11: [UNESCORTED]
RESTRICTED ACCES12: [UNESCORTED]
RESTRICTED ACCES13: [UNESCORTED]
RESTRICTED ACCES14: [UNESCORTED]
RESTRICTED ACCES15: [UNESCORTED]
RESTRICTED ACCES16: [UNESCORTED]
RESTRICTED ACCES17: [UNESCORTED]
RESTRICTED ACCES18: [UNESCORTED]
RESTRICTED ACCES19: [UNESCORTED]
RESTRICTED ACCES20: [UNESCORTED]
Text58:
Text57:
Text59:
Text60:
Text51:
Text52:
Text54:

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