Form 3-2530 California/Nevada/Klamath Basin, OR Annual Reporting For

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

CALIFORNIA / NEVADA / KLAMATH BASIN, OR
Section 10(a)(1)(A) Recovery Permit
Annual Summary Report
U.S. FISH AND WILDLIFE SERVICE

FROM:
Activities Conducted in Calendar Year: 2018

Date Submitted

Permit Number:

TE -

Permit Expiration Date:

Permittee/Principal Officer Name:

Organization Header/Business Contact Information
TO: Field Office Recovery Permit Coordinator (Check all that apply)
Arcata

Hopper Mountain

Southern Nevada

Bay-Delta

Klamath Falls

Ventura

Carlsbad

Reno Sacramento

Yreka

Desert Tortoise Recovery Office

SPECIES IDENTIFIED ON PERMIT:
Activities Conducted (Enter Species Name
Only):

No Activities Conducted (Enter Species Name Only):

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FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

2018

INCIDENTAL TAKE

TE -

No Incidental Take

OTHER PERTINENT OBSERVATIONS (if applicable)

PLANNED FUTURE ACTIVITIES AUTHORIZED BY THIS PERMIT

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FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018

TABLE 1
Field Offces

Permitted in this
Jurisdiction
(see permit and check all
that apply. If checked, fll out
cells to right as applicable)

Did not Conduct Activities
Within this Jurisdiction

Conducted Activities Within
this Jurisdiction
(if checked, fll out Table 2)

Arcata
Bay-Delta
Carlsbad
Desert Tortoise Recovery
Offce
Hopper Mountain
Klamath Falls
Reno
Sacramento
Southern Nevada
Ventura
Yreka

I certify that the information in this report and attached tables fully and accurately represents my/our activities. Approved by
Principal Offcer/Permittee

Name of Principal Offcer/Permittee
(Type Your Name Here)

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FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018

TABLE 2
Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for
which Activity
was Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(field office and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 4 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018

TABLE 2
Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for
which Activity
was Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(field office and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 5 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018

TABLE 2
Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for
which Activity
was Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(field office and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 6 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018
TABLE 2

Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for
which Activity
was Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(field office and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 7 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018
TABLE 2

Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for
which Activity
was Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(field office and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 8 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018
TABLE 2

Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for
which Activity
was Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(field office and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 9 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

Annual Summary Report

OMB Control No. 1018-0094
Expires ##/##/20##

TE -

2018
TABLE 2

Report Title

Agency or Company
Who Produced Report
(if applicable)

General Location
(e.g., city or
community, county)

Species for which
Activity was
Conducted

Present

Absent

Report Submitted to
Recovery Permit
Coordinator
(feld offce and date
submitted;
e.g., mm/dd/yyyy)

GIS or
Other Data
Submitted
(If applicable,
see Instructions)

Page 10 of 11

FWS Form 3-2530 (Rev.10/2020)
U.S. Department of the Interior

OMB Control No. 1018-0094
Expires ##/##/20##

NOTICES
PRIVACY ACT STATEMENT
Authority: The Endangered Species Act (16 U.S.C. § 2404)
Purpose: The information collected will be used to determine if the applicant meets or continues to meet issuance
requirements for the particular activity they are requesting to conduct with respect to endangered and threatened species.
Routine Uses: The information collected may be shared in accordance with the Privacy Act of 1974 and the routine uses
listed in the System of Records Notice INTERIOR/FWS-21 Permits System (June 4, 2008) 73 FR 31877, available at https://
www.doi.gov/privacy/doi-notices.
Disclosure: Furnishing this information is voluntary; however, failure to provide the requested information may prevent the
FWS from being able to issue the permit.
PAPERWORK REDUCTION ACT STATEMENT
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501 et seq.), the U.S. Fish and Wildlife Service collects
information necessary as a required condition of permits requested and authorized under the applicable laws governing the
requested activity, and to respond to requests made under the Freedom of Information Act and the Privacy Act of 1974.
Information requested in this form is purely voluntary. However, submission of requested information is required in order to
process applications for permits authorized under the above laws. Failure to provide all requested information may be
sufficient cause for the U.S. Fish and Wildlife Service to deny the request. According to the Paperwork Reduction Act of
1995, an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it
displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No.
1018-0094.
ESTIMATED BURDEN STATEMENT
We estimate public reporting for this collection of information to average 30 minutes, including time for reviewing instructions,
gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or
any other aspect of the form to the Service Information Clearance Officer, Fish and Wildlife Service, U.S. Department of the
Interior, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]. Please
do not send your completed form to this address.
FREEDOM OF INFORMATION ACT
For organizations, businesses, or individuals operating as a business (i.e., permittees not covered by the Privacy Act), we
request that you identify any information that should be considered privileged and confidential business information to allow
the Service to meet its responsibilities under FOIA. Confidential business information must be clearly marked "Business
Confidential" at the top of the letter or page and each succeeding page and must be accompanied by a non-confidential
summary of the confidential information. The non-confidential summary and remaining documents may be made available to
the public under FOIA [43 CFR 2.26 – 2.33].

Retention: Permanent

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