No Form number Application for Additional Base (Class 3 Native--existin

OMS No. 0581..0178

FAR WEST SPEARMINTOILADMINISTRATIVECOMMITTEE
100 North Fruit/and, Suite B
Kennewlck, WA 99336
(509) 585-5460

APplication For Additional sase
CLASS 3 (NATIVE)

PulSUantto Section 986. 163

C-2, I hetBby 18Quest that tile approplate quanflty 01additional

base be issued tome etfective June 1, 20_

AdditionatBase wm Be Added To:

(If moAJthan one entity, p/eaU cirde entily to trJC8iVeadditonaJ base)
Signed
OMBIf. 0581..(}178

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