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<br /> BUREAU OF ALCOMOI.TOBACCO AI�RREARYS
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<br /> ��pPUCATION FOR UCENSE OR PERWT ,��
<br /> UNDER 18 U.S.C.CHAP7'ER�0►EXPLOSIVES � ��`
<br /> NOTE PLEASE COMPLETE IN DUPUCATE,USING 7YPEW RITER OR BALL POINT PEN
<br /> ° SECTION A(Must be completed by all applicants) ,. . _--_----._._,___. _
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<br /> 4.NAME OF COUNTY S.AGOf�SS(FFD a�1 ro..db.90�.�CaM)
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<br /> 9.IS OR WLL rOUR BUSiNESS BE:(Grdc appapri�baa�
<br /> � kdi�Wy OrrtMO � A Partrryiip A Carpor�on �dwr(S�
<br /> 10.APPIICATION IS�AADE FOR A UCENSE OR PERAAfT U�DEfl t!U.S.C..G111PTER 11.DUFiNG TfE TERM OF T►E LK�NSE OR PERIYIR.7HE APPIICANi MJTENOS TO
<br /> 10 AS A:(Sw n�.tian and clNck�pprapif�Em[) MMRIF�K.'R1iE.Y'ORi.DEAL ORi USE:
<br /> �� EXPlO�1VE8 LK:BI� X F'� �iWu�oir for d�6�Nfors d rJ�w�s d�b�iws)
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<br /> 29 ��a►HOh 12 UST T}E TYPES Of EXPLOSNES MATERULS YOU INTEID TO MANUFACTURE.IMPORT,
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<br /> E�LOWES iElrff 13.IS STATE OR LOGAL LICENSE OR PERMR REOUIRED FOH EXPLOSNES OPERATIONS7
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<br /> 36 Uav(�irt�W Miph F.�plaiws 11.DAIE OPERI1T10NS REOUWNG A LK�1SE OR PERAIR AHE DESIRED TO COMMAENCE:
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<br /> _ 2� -�t�l� . �, 1q4 $
<br /> �►se �r aoEn P�r�ro nE-..,
<br /> -su�►u rosncoo mo r��wa- rarK�r s
<br /> STORAGE FACILfTY DATA(Must bs eompNb011�rploslw maNriafs wlll W stor� .
<br /> S�etion 942�.18 U.S.C.povid�s'It dr1 b�udwM�l lor arry pwaon b�ow ay��io�iN m�rid in a m�rnv not i�cw�lomrtp wMh ipulmors P�d M��Y•��+iDW!^�0�• .
<br /> liwrw a pwmiL ths�ppbpnt mwt rNd and 6�Mia wiw tr�quir�s sM IoAi i�27 CFR P�r155.SuEPr�K-STORAGE AN APPLICATION FOR A LICE�E YV0.L BE DENIED IF UPON
<br /> AN MiVEST1GAT10N IT IS fOUND THAT STOqACiE FACIfTES ARE�i110EOUATE _ . _ . .
<br /> t S.ALL OF THE STORAGE FACILfT1ES LISTED ON A7TACIfD S1fEi5.�ANY.MEE�T/E 1Af1AlUlA�REHTS AS SET FORTH N 27 CFFI PART 55.SUBPART K-STORA(3E(fl No.
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<br /> 16.TYPE.LOCATION ANO OESCFi1PT10N OF EACM PEiM/MBdi SiiORM'#FACLRY(Atlr.fi Mpr��fwps)•SN irrtursar t.t t and 16) •
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<br /> 17.IYPE M!D DESCRIPTION OF EACM POHfABLE OR MOBtE FACL(TY IArrb wp�W drM{s)-SM irrudorr 1,11.�d ta)
<br /> 5 e2 /�t-�1�a�1�rn�er� �t De St,r i P��a� p� p���-c�b I.e, ►r,�c�ai 2 ,,.,� _
<br /> ATF F 5400.13/5400.16 t3�9o1 PAEv�Ot1S ED(T10N IS OBSOLETE
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