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Get CA CHP 398 2006

State of California Department of California Highway Patrol PERMIT APPLICATION FOR ACTIVITY ON STATE PROPERTY CHP 398 Rev. 1-06 OPI 065 ALL INFORMATION MUST BE PROVIDED Attach additional sheets if necessary ORGANIZATION/APPLICANT NAME ADDRESS STREET CITY STATE ZIP CODE DO NOT USE P. O. BOX CONTACT PERSON TELEPHONE NUMBER FACSIMILE NUMBER DATE S OF ACTIVITY/EVENT MONTH DAY YEAR NUMBER OF PARTICIPANTS IDENTIFICATION OF SECURITY NAME ADDRESS AND TELEPHONE NUMBER OF SECURITY PERSONNEL OR COMPANY AND DESCRIPTION OF EMBLEM OR I. D. TO BE WORN SPECIFIC LOCATION OF ACTIVITY BUILDING MANAGER CONTACTED YES DEPARTMENT NO ADDRESS DESCRIPTION OF ACTIVITY SET-UP TIME a*m*/p*m* STARTING TIME a*m*/p*m ENDING TIME A. M. /P. M. LIST ITEMS USED FOR YOUR ACTIVITY INCLUDE SIGNS POSTERS TABLES SOUND SYSTEMS EQUIPMENT OR OTHER ARTICLES CONTACT ALCOHOLIC BEVERAGE CONTROL ABC IF ALCOHOLIC BEVERAGES ARE TO BE SERVED. WILL ALCOHOLIC BEVERAGES BE SERVED IF YES ABC CONTACTED ABC LICENSE REQUIRED IF YES ATTACH A COPY OF THE ABC ONE-DAY ALCOHOLIC LICENSE IF NO ABC EMPLOYEE SIGNATURE NAME S ADDRESS ES AND PHONE NUMBER S OF PERSON S RESPONSIBLE FOR CLEAN-UP AFTER ACTIVITY Applicant accepts financial liability for any damages to state property by members of his/her party and further agrees to leave the event area clean* Applicant signature below reflects agreement with the rules governing use of state property all terms and conditions of this permit and/or any amendments to said permit. APPLICANT SIGNATURE PRINT NAME DATE THIS APPLICATION BECOMES A PERMIT FOR ACTIVITY ON STATE PROPERTY WITH AUTHORIZED SIGNATURE FROM THE CALIFORNIA HIGHWAY PATROL CHP USE ONLY ADDITIONAL TERMS AND CONDITIONS Print Completed Page COMMANDER OR DESIGNEE SIGNATURE DATE AND TIME RECEIVED CONFIRMATION/PERMIT NUMBER Use previous editions until depleted c398106. O. BOX CONTACT PERSON TELEPHONE NUMBER FACSIMILE NUMBER DATE S OF ACTIVITY/EVENT MONTH DAY YEAR NUMBER OF PARTICIPANTS IDENTIFICATION OF SECURITY NAME ADDRESS AND TELEPHONE NUMBER OF SECURITY PERSONNEL OR COMPANY AND DESCRIPTION OF EMBLEM OR I. D. TO BE WORN SPECIFIC LOCATION OF ACTIVITY BUILDING MANAGER CONTACTED YES DEPARTMENT NO ADDRESS DESCRIPTION OF ACTIVITY SET-UP TIME a*m*/p*m* STARTING TIME a*m*/p*m ENDING TIME A. D. TO BE WORN SPECIFIC LOCATION OF ACTIVITY BUILDING MANAGER CONTACTED YES DEPARTMENT NO ADDRESS DESCRIPTION OF ACTIVITY SET-UP TIME a*m*/p*m* STARTING TIME a*m*/p*m ENDING TIME A. M. /P. M. LIST ITEMS USED FOR YOUR ACTIVITY INCLUDE SIGNS POSTERS TABLES SOUND SYSTEMS EQUIPMENT OR OTHER ARTICLES CONTACT ALCOHOLIC BEVERAGE CONTROL ABC IF ALCOHOLIC BEVERAGES ARE TO BE SERVED. M. /P. M. LIST ITEMS USED FOR YOUR ACTIVITY INCLUDE SIGNS POSTERS TABLES SOUND SYSTEMS EQUIPMENT OR OTHER ARTICLES CONTACT ALCOHOLIC BEVERAGE CONTROL ABC IF ALCOHOLIC BEVERAGES ARE TO BE SERVED. WILL ALCOHOLIC BEVERAGES BE SERVED IF YES ABC CONTACTED ABC LICENSE REQUIRED IF YES ATTACH A COPY OF THE ABC ONE-DAY ALCOHOLIC LICENSE IF NO ABC EMPLOYEE SIGNATURE NAME S ADDRESS ES AND PHONE NUMBER S OF PERSON S RESPONSIBLE FOR CLEAN-UP AFTER ACTIVITY Applicant accepts financial liability for any damages to state property by members of his/her party and further agrees to leave the event area clean* Applicant signature below reflects agreement with the rules governing use of state property all terms and conditions of this permit and/or any amendments to said permit. .

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