"Osage Mineral Reserve Trucking Permit"

Osage Mineral Reserve Trucking Permit is a 1-page legal document that was released by the U.S. Department of the Interior - Indian Affairs, Osage Agency and used nation-wide.

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OMB# 1076-0180
Expires 1/31/2020
OSAGE MINERAL RESERVE
TRUCKING PERMIT
Permit Number
Name of Permittee:
1.
Mailing Address:
2.
Make of Truck:
3.
Year of Truck:
4.
Color of Truck:
5.
Vin of Truck:
6.
Vehicle Tag No.:
7.
Size of Truck:
8.
Permitted Fluid:
9.
Permit Valid From:
10
To
Telephone Number:
11
Signature of Permittee:
12
Date:
13
Permit is non-transferable. Permittee agrees to abide by all regulations and Superintendent's
orders concerning trucking and transporting operations. This permit may be revoked
without notice by the Superintendent or her authorized representative.
Approved
Supervisory Petroleum Engineering Technician
Date
OMB# 1076-0180
Expires 1/31/2020
OSAGE MINERAL RESERVE
TRUCKING PERMIT
Permit Number
Name of Permittee:
1.
Mailing Address:
2.
Make of Truck:
3.
Year of Truck:
4.
Color of Truck:
5.
Vin of Truck:
6.
Vehicle Tag No.:
7.
Size of Truck:
8.
Permitted Fluid:
9.
Permit Valid From:
10
To
Telephone Number:
11
Signature of Permittee:
12
Date:
13
Permit is non-transferable. Permittee agrees to abide by all regulations and Superintendent's
orders concerning trucking and transporting operations. This permit may be revoked
without notice by the Superintendent or her authorized representative.
Approved
Supervisory Petroleum Engineering Technician
Date