Trucking Permit

Leasing of Osage Reservation Lands for Oil and Gas Mining (25 CFR 226)

Osage_Trucking Permit

Lessee or operator must submit application for trucking permit

OMB: 1076-0180

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OMB# 1076-0180

Expires XX-XXXX







OSAGE MINERAL RESERVE

TRUCKING PERMIT



Permit Number


1.

Name of Permittee:

2.

Mailing Address:








3.

Make of Truck:

4.

Year of Truck:

5.

Color of Truck:

6.

Vin of Truck:

7.

Vehicle Tag No.:

8.

Size of Truck:

9.

Permitted Fluid:

10

Permit Valid From:

To


11

Telephone Number:

12

Signature of Permittee:

13

Date:

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


File Typetext/rtf
AuthorJ_Tallchief
Last Modified BySYSTEM
File Modified2018-07-31
File Created2018-07-31

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