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2015-06-26_REVISION - M2005077
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2015-06-26_REVISION - M2005077
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Entry Properties
Last modified
6/16/2021 2:12:38 PM
Creation date
7/8/2015 8:35:46 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M2005077
IBM Index Class Name
REVISION
Doc Date
6/26/2015
Doc Name
Application SO01
From
Upland Gravel, Inc.
To
DRMS
Type & Sequence
SO1
Email Name
SJM
GRM
Media Type
D
Archive
No
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Sec. 18. Effective date - This contract becomes effective as indicated below. <br />❑✓ If this contract becomes effective on the date BLM signs the contract, BLM will check this box. <br />❑ If this contract becomes effective only after certain conditions are met, BLM will check this box, list the conditions below, and indicate the <br />effective date. <br />Sec. 19. Appeal - You may appeal any decision that BLM makes in regard to this contract under Parts 4 and 1840 of Title 43 of the Code of Federal <br />Regulations. <br />The following parties have executed this contract as of: <br />PURCHASER <br />Upland Gravel Inc. <br />(Individual or Firm Name) <br />152 32 Road, Grand Junction, CO 81502 <br />(Address) <br />(970) 434-0510 <br />(Phone Number — include area code) <br />(Signature) <br />(Signature) <br />If you are a corporation, affix corporate seal here: <br />THE UNITED STATES OF AMERICA <br />By Katie Stevens <br />(Print Name of BLM Official) <br />,e"-, .,4� <br />(Signature of BLM Official) <br />Field Manager <br />(Title) <br />`7 - /O - (4r - <br />(Date) <br />Title 18 U.S.C. 1001, makes it a crime for any person knowingly or willfully to make to any department or agency of the United States any false, fictitious or fraudulent <br />statements or representations as to any matter within its jurisdiction, subject to a fine of up to $10,000 and imprisonment up to 5 years. <br />NOTICES <br />The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following information in connection with information <br />required by this application. <br />AUTHORITY: 30 U.S.C. 601 et seq.; 43 CFR Group 3600 <br />PRINCIPAL PURPOSE: BLM uses this information to identify the parties entering into contracts for disposing of mineral materials. <br />ROUTINE USES: BLM will transfer information from the record or the record itself to appropriate Federal, State, local, or foreign agencies, when <br />relevant to criminal, civil, or regulatory investigations or prosecutions. <br />EFFECT OF NOT PROVIDING INFORMATION: If you do not provide this information to BLM, we will not be able to process your application for <br />a contract. <br />The Paperwork Reduction Act requires us to inform you that: <br />The BLM is collecting this information to process your application and effect a binding contract. <br />The BLM will use this information to identify and communicate with applicants. <br />You must respond to this request to get a benefit. <br />You do not have to respond to this or any other Federal agency -sponsored information collection unless it displays a valid OMB control number. <br />BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to average about 1 hour per response, including the time for <br />reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate <br />or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-0103), Bureau Information Collection Clearance <br />Officer (WO -630),1849 C Street, N.W., Room 2134LM, Washington, D.C. 20240. <br />(Form 3600-9, page 3) <br />
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