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HomeMy WebLinkAboutAgreement APPLICANT 4/26/2006 . . A Weyerhaeuser KEYITAG PERMIT -p.springfield Operations P.O. Box 275 Springfield, OR 97477 (541)746-2511 o South Valley Operations P.O. Box 1819 Eugene, OR 97440-1819 (541)744-4600 Issued to: Company Name: Issue Date: I Permittee Name: I U Phone: Address: PO fp Y- / D h 7 City, State, .~ip: Number ofkeys:~ Key type:~ Key #:..3.:JL Issued by: Jj (), Number of tags: -=- Tag #: Issued by: , Type of activity: f0 u. ~e.. 1Ptiltt"5'j /fItn !!:at Area of use: tru (I t rrl Expected date of return: 10 /30 /() 0 I I AGREEMENT: 1, Permit holder agrees to abide by all terms and conditions contained in this permit, including those on the reverse side of this form. This permit must be available for inspection upon request of Weyerhaeuser employees or security personnel. 2. Use of key and tag is for intended use only, as identified above. Use for any other purpose or violation of the terms and conditions listed herein will be considered illegal activity subject to prosecution. 3. Gate procedures listed on the reverse side of this form must be followed. 4. Report any fire, vandalism or suspicious circumstance to the respective forest operations listed above. 5. Return keys and tags to Weyerhaeuser upon completion of use or upon request ofWeyerhaeuser representative. , 6. A $ Ii deposit will be charged for each key and/or tag issued. This deposit will be refunded whe~/tag is returned (even if damaged). The deposit may be retained or deducted from future contractor payments if keys/tags are not returned. Total deposit received: $' d, D Withholding account number: Deheck D~ Authorized by: (Weyerhaeuser 'Received by: (permittee or Represen!Ji . KeylTag returned: Deposit returned: White - Gate Yellow - Permittee Pink - Authorizer