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