Attachment 6 - DL1818.pdf
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- SP330023R0002
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Defense Logistics Agency Distribution
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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
PRIVACY ACT STATEMENT
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
(IF APP)
11.
Social Security No.
12.
DATE OF BIRTH
13.
DL State & Number
14. 15.
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:
PerFORM (DLA)
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| Text5: 6/06/2023 |
| Text6: 6/06/2023 |
| Text7: Tim Kielbowick |
| Text8: 717-770-6128 |
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| 0: Site visit for new janitorial contract. |
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| Text17: Please fax to both X5480 & X8146. |
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