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Page 1: Name of Company: - Farmington, NM of Company: _____ Serial Number: _____ Description of Filming Activities by Location Name ofLegal Description or reference Staging area(s) requested

Name of Company: ______________________ Serial Number: ______________________

Description of Filming Activities by Location

Name of Location: ____________________________________________________________________ Legal Description or reference points: _____________________________________________________ Staging area(s) requested for filming in this location: _________________________________________ Description of Proposed Filming Activities. PLEASE PROVIDE INFORMATION FOR ALL THAT APPLY. A. Cast and crew Number of cast & crew, including local crew: ___________________________________________ Director:________ __________ Producer: __________________ 1st Asst. Director: _______________ Location Mgr: ___________________ Local Monitor ____________________________ 2nd Unit? ____ yes _____ no Local Monitor for 2nd Unit: _____________________________ B. Vehicles Camera cube & size: ________ Grip truck & size:___________ Prop truck & size: _________________ Picture car transport & size: _________Number of picture cars:_______ Production cube & size: _____ Motorhome(s):______ Crew transport vehicles: __________ Caterer vehicles: ______________ ATVs or mules: _________ Livestock truck & size: ____________ Other: ______________________ Total Number of vehicles: ________________ C. Duration

Number of set-up days: ______ Number of filming days: _______ Number of clean-up days: ________ D. Camera mount (check those that apply): Hand _____ Tripod ____ Dolly ____ Dolly track footage ____ Crane or jib arm ___ Arm footage ____ Portable crane _____ Car mount ___ Camera car, shot maker, or process trailer ____ Helicopter _____ E. Information for HELICOPTER USE only

List locations of base staging for each filming area ________________________________________________________________________________________________________________________________________________________________________ List location of landing zones (LZs) ________________________________________________________________________________________________________________________________________________________________________ F. Information for locations where RIGGING is required _______________________________________________________________________________________ For “over the edge” rigging: Describe in detail what, whom, and how suspension over the edge is proposed __________________________________________________________________________________________________________________________________________________________________________________ Drilled bolt anchors or natural anchors?____________________ Number of prep days required __________

Page 2: Name of Company: - Farmington, NM of Company: _____ Serial Number: _____ Description of Filming Activities by Location Name ofLegal Description or reference Staging area(s) requested

G. Information for use of LIVESTOCK AND/OR TRAINED ANIMALS

Number and type of animal:_________________ Manner of transportation: __________________ Special staging/corralling needs on BLM lands: ______________________________________________ H. Information on PROPS, SET CONSTRUCTION, OR SPECIAL EFFECTS (describe in detail)