Exhibit__012_PBA_Visitor_Notification_Form.pdf

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10.0.2.20120224.1.869952.867557

FOR OFFICIAL USE ONLY - OPSEC SENSITIVE

PBA VISITOR NOTIFICATION FORM

PBA Form 190-21 FOR OFFICIAL USE ONLY - OPSEC SENSITIVE

VISIT INFORMATION

ARRIVAL DATE

DEPARTURE DATE

GENERAL AREA (G)

MANUFACTURING & GENERAL AREA (MG)

DEPO & GENERAL AREA (DG)

DEPO MANUFACTURING & GENERAL AREA (DMG)

CAMERA PASS (REQUIRED FOR RESTRICTED AREAS (M&D)

VISITOR INFORMATION

ORGANIZATION/COMPANY NAME

PURPOSE OF VISIT

***Current Approved Foreign National Screening Must Be Attached For All Non-US Citizens***

FIRST NAME

LAST NAME

U.S. CITIZEN

CONTACT NUMBER

SPONSOR INFORMATION

FIRST NAME

LAST NAME

ORGANIZATION

CONTACT NUMBER

COMMENTS

October 2015