Day Tour Access form CatDel UV

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DAY TOUR ACCESS FORM
Carter H. Strickland Jr.
Commissioner
Kevin T. McBride
Deputy Commissioner
Bureau of Police & Security
Peter Fusco
Chief of Department
DEP Police
[email protected]
NOTE: This form is to be completed by persons attending tours of NYC DEP Critical
Infrastructure. Each individual shall complete the requested information below and
submit to the NYC DEP Police. The NYC DEP Police will notify the individual, and
sponsoring DEP Entity (if applicable) if access to Critical Infrastructure site is
granted.
Future access beyond the tour date will require submission of a new form
Photo identification must be carried by all tour members. Expired
identification will not be accepted.
PLEASE PRINT (clearly)
Today’s Date: __________Expiration Date: __________ (POLICE TO FILL OUT)
2 Walker Road
Valhalla, NY 10595
T: (914) 593-7550
F: (914) 593-1845
Location of Tour: Catskill/Delaware UV Plant
Date(s) of Tour: April 22, 2014
Name (last, first, middle initial)
__________________________________________________________________
Date of Birth: ___/___/___
Drivers License #: ____________________ State issuing License: ____________
( IE – NY, NJ, PENN, CONN)
If no license, list another form of a government issued photo identification with ID #:
__________________________________________________________________
Group or Affiliation: _________________________________________________
I hereby affirm that the above information is true and agree to comply with all NYC
DEP Policies during my tour of the above stated location:
SIGNATURE: ____________________________________
Providing false or misleading information or identification, or providing no form of
government issued photo ID will result in denial of access to NYC DEP facilities.
This form must be faxed or emailed with a cover letter with a return call back
number to: Eastview Command Center @ 914-345-1840 [email protected]
or the Ashokan Dispatch @ 845-657-6145 [email protected]
If you do not receive call back, contact Eastview at 914-593-7500 or Ashokan
845-657-8433 to follow up to check if the individual is cleared for the day.
Rev. 9-19-2011
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