Omak Municipal Airport Emergency Land Use Information Form

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BILLING AND CONTACT INFORMATION

COMPANY NAME *

PILOT NAME *

BILLING ADDRESS *

PHONE NUMBER *

EMAIL ADDRESS *

AIRCRAFT INFORMATION

TYPE OF AIRCRAFT

AIRCRAFT MODEL

TAIL NUMBER *

INCIDENT OR EMERGENCY

INCIDENT NAME

INCIDENT NUMBER

DATE OF ARRIVAL

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TIME OF ARRIVAL

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TIME OF ARRIVAL AM

TIME OF ARRIVAL PM

DATE OF DEPARTURE

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TIME OF DEPARTURE

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TIME OF DEPARTURE AM

TIME OF DEPARTURE PM

AIRPORT FEES

TIE DOWN FEES

NON-COMMERCIAL - $15.00/MONTH

COMMERCIAL - $20.00/WEEK

NONE

WEEKLY NON-UNIFORM SPACE FEES

LENGHT (FT) X WIDTH (FT) X $0.01

FUEL FLOWAGE FEES

NUMBER OF GALLONS PUMPED

#GALLONS X $0.10/GALLON

TOTAL AMOUNT OF FEES

TIE DOWN + NON-UNIFORM SPACE + FUEL FLOWAGE FEES

Contact Information