HomeMy WebLinkAboutFederal license application T . ...�....,r.r... ..... .... . . . . .
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BUREAU OF ALCOMOI.TOBACCO AI�RREARYS
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��pPUCATION FOR UCENSE OR PERWT ,��
UNDER 18 U.S.C.CHAP7'ER�0►EXPLOSIVES � ��`
NOTE PLEASE COMPLETE IN DUPUCATE,USING 7YPEW RITER OR BALL POINT PEN
° SECTION A(Must be completed by all applicants) ,. . _--_----._._,___. _
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4.NAME OF COUNTY S.AGOf�SS(FFD a�1 ro..db.90�.�CaM)
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9.IS OR WLL rOUR BUSiNESS BE:(Grdc appapri�baa�
� kdi�Wy OrrtMO � A Partrryiip A Carpor�on �dwr(S�
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
10 AS A:(Sw n�.tian and clNck�pprapif�Em[) MMRIF�K.'R1iE.Y'ORi.DEAL ORi USE:
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29 ��a►HOh 12 UST T}E TYPES Of EXPLOSNES MATERULS YOU INTEID TO MANUFACTURE.IMPORT,
2t Mr��d�-�'� �ep DFJ1L OR USE(W..O�nriYl�.TNT.Bl�cic Powdr,Fi+walo,My
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E�LOWES iElrff 13.IS STATE OR LOGAL LICENSE OR PERMR REOUIRED FOH EXPLOSNES OPERATIONS7
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36 Uav(�irt�W Miph F.�plaiws 11.DAIE OPERI1T10NS REOUWNG A LK�1SE OR PERAIR AHE DESIRED TO COMMAENCE:
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STORAGE FACILfTY DATA(Must bs eompNb011�rploslw maNriafs wlll W stor� .
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�• .
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
AN MiVEST1GAT10N IT IS fOUND THAT STOqACiE FACIfTES ARE�i110EOUATE _ . _ . .
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.
�on MPrab�M�t)
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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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17.IYPE M!D DESCRIPTION OF EACM POHfABLE OR MOBtE FACL(TY IArrb wp�W drM{s)-SM irrudorr 1,11.�d ta)
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ATF F 5400.13/5400.16 t3�9o1 PAEv�Ot1S ED(T10N IS OBSOLETE
DEPARTMENT OF THE TREASURY—BUREAU OF ALCOHOL,TOBACCO AND FIREARN.S REFERRAI NO.(OptioncJJ
-- � REFERRAL OF INFORMATION �'�
(See Instn�crions on bockJ � ��- ��_ �J�' /- �'S
PAR7 1— REFERRAI
1.TO: (Title,cgcnc}�and oddressJ , 2.DATE
• Lyle Oman, Building Official
City of Crystal Bay
P.O. Box 66
Crystal Bay, MN 55323
June 15, 1998
The foilowing information and attachment fChetk appliccblt boxf ❑are sent to you as requested, �are referred to you for consideration
as potential criminal or civil viotations coming under your jurisdiction. _ .
COMPLETE r0h nEr�nrzALS i�n n'cuUESTS OUTSI�E ATF— ❑ DOES � DOES NOT c��tain contidential returns or return intormation
under 26 US.C.6103.
COMPLETE iF APPLICABLE: This is a confirmation ot a referral made ❑by telephone ❑in person on .
3.NAMEIS)OF PRINCIPALS INVOLVED IN POSSIBLE VIOLATION 4.STATUTEIS)POSSIBLY VIOLATED
• i�:i;�n3� (;C::TSc,it
Gradient Technology Not applicable
5.FEDERAL LICENSES AND/OR PeRMITS HELD(T��pe cnd numberJ .
MN 33 12302
� 6.ATF OFFICER UNCOVERING POTENTIAL VIOLATION 7.POST OF DUTY
Rob Schellhorn, ATF Ins ector St. Paul , MN
8.SUMMARY OF SIGNIFICANT FACTS AND/OR EXPLANATION OR DESCRIPTION OF ATTACHMENT(Contrnue on a seperare sheet,if necesmry.J
The person(s) or company listed above have applied for a federal license or permit to use,
manufacture or store explosives. The address listed above is where the applicant intends
to conduct their business. If storage of explosives at that address would violate federal
law, we will require that the explosives be stored at another location that would meet
federal storage requirements.
We are conducting an inspection of these facilities to. determine if the activity they intend
to �conduct is lawful under federal ]aw. We are referring this information to you so you
can conduct your own inspection if you wish and to ]et you know that explosives materials ma
be present at the address 1Tsted above if we app rove the license or permTt.
If you have any information concerning the applicant(s) or if there are local ordinances whi h
would prohibit the operation of an explosives business at the address listed above, please
let this office know. If you have any questions cancerning this referral , please call the
ATF office listed below.
9.ATFfJFFiCI APP G REFEJFiRAL(Signa eJ
/ . �-G
.TITLE D ADORESS 11.TELEPHONE NO.
Area Supervisor
30 E. 7th St. , Suite 1840 �
St. Paul, MN. 55101 _ _ _ ..._ (612)290-3496
PART 11— RESPONSE(Se�lnstruclion 4.J
1.THE REFERRAL ABOVE IS D ACCEPTED ❑REJECTED f£xplain belowJ ❑OTHER(Explain belowf. 2.DATE
3.ACTlON PLANNED OR TAKEN AND COMMENTS(Cor.tinue on a separale sheet,irnecessary.J
4.SIGNATURE 5.TITLE OF OFFICIAL
6.ADDRESS 7.TELEPHONE NO.
CQl��pi eTe����eFep4G1 �Unru��:P.Te: �'u.e oL�^�•:�e is r"1 ��Teo�r� fl e�.•�� .
�'F F 5000.21 (1-6<) PREv10L'S E71T10N5 ARE CESOLE7E
:°:'. ::' ..�: ... . . . . : . . . .. . . . . . . .. . .. . .
• - ' � lNSTRUCTIONS ' ' -
1. PURPOSE Use this tortn to intert�aly reter potentia! viala- _ 3. DISTRIBUTION
tions oi ATF administered statutes and.to extemally re(�to � ''�
the appro�riate._.Federai, State or local eniorcemenU a Ori�inal, with any ariachmenta, and ths rec[pient's
repuiatory apency poiential violations of other statutes.Also, response copy to the appropriate ATF otticial ot ather
use this form to transmit infom�ation(includinp conGrtnation apency.lf form is used to transmit requested lnfortnation,
oi oral transmittals)to,or to dxument inspections(on-site) do not include response copy,
by, another Federal, State o�Ixal agenry� that identifies, „
directly or indirectly� a licensee..permittee, taxpayer� appli- b. Copy tot repional office licensee or permittee ille,when .
cant,or any person(individuai,paAnership,corporation,etc.), referrinp potentiai violations.
connected with, or alieped to have committed, a possible
violation oi,or to have incuned a possible Iiabiiity for tax or c. Copy for the apprrning otficial's file,when referrinp poten-
other imposition under,any Federal statute enforced by ATF, tial violations.
2 PREPARATION d. Make additional copies when necessary for: �
a. The ATF officer uncoverinp the potential violation or� in (1) Tax and Trade Compifance Branch, Buresu Head-
the case of a transmittal of requested iniormation,ihe ap� quarters,wrien referrinp FAA Act tradc practices viota-
propriste individual wlll compleie items 3 throuph 8 in PaR tions to State or Ixal agencies.
I,as applicable.
(� Otfice of Pubiic Aftairs, Disclosure Branch� Bureau
b. The approving ATF otficial wili compiete the remaininp . HeadquaAers. when reterrinp to a State agency
items in Part I.For reterrais by Law Enforcement,the RAC retums or retum information under 26 U.S.C.6103.
or SAC is the approving official.ln the case ot referrals by
Compiiance Operations personnel,the approvin�official 4. RESPONSE
is the CFO or CTS,excepl that reierrals concerninfl tire� �'
arms and explosives matters may be approved by the a. ACTION BY RECIPIENT ATF OFFICE Complete Part II
Supervisor. Firesrma and Explosives Licensinp Section. and retum to the oripinatinp ofiice wlthin 10 workinp days
Referrals of FAA Act trade practices violations,to Law En- of receipt ot a referra�oi potential violations.Submit an in�
forcement and other FEDERAL apencies will be approved terim response ff an investigation will continue past the
by the Chief,Tax and Trade Comatiance Branch.Refercais 10�day period, and a tinal response upon completion of
by the Repulatory Audit Staft will be approved by the the investipation. .
repionai audit manaper. �
b. ACTION BY OTHER RECIPtENT AGENCY. Please cort►�
. � plete PaA II when a retenal ot potential violations und�
� � .. your jurisdictioa has been received and retum to ihe
_ oriflinatinp oNicc�.. - . -
- ... . ._ . .,_ . .
_ -- •
• � PAPERWORK REDUCTION ACT NOTICE � � '' ' " � '� �
This request ia in acoordar�with 1he Paperwork Reduction�,ct ot 1980. This iniormation collectlon is used to determine the reapor�so of and valw to,otfier
Federat and Sta4e gavernment agencies and bodies of iniorrt�ation suppl'ied by ATF ATF inany usa the response to coordinate actions of iaw eniwoement
Tha information is voluntary. .
The estimated average burden associated with this colleeti�of information is 1 h�ur(s)par respondant or►ecordkeeper,depending on indhridual ci►cum-
stances. Comments conceming tM a�rary ot tliis burden astimate and suggestion tor reduang this burden should be addressed to Raports Management
Otfic�r.Iniormation Programs Branch,Bureau of Ak:ohd,Tobaxo and Fnearms,Washington,D.C.20226,ar►d the Office o(Management and Budge�
Paparwork Reduation Project(1512-003�,Washington,D.C.20503.
A7F F 500021 (�-6c)