5460-015 Log Scale and Disposiiton of Timber Removed Report

Form 5460-015 (March 2019) UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT LOG SCALE AND DISPOSITION OF TIMBER REMOVED REPORT
							FORM APPROVED OMB Control Number: 1004-0058 Expires: 11/30/2022
							Contract Number
							Date
Purchaser’s Name				Address (include zip code)
In compliance with requirements of the above-numbered Timber Sale Contract, we hereby submit the following log scale for the total volume of timber removed from the contract area covered by said contract.
SPECIES	GROSS SCALE	VOLUME OF TIMBER REMOVED (MBF)
		SOUND LOGS*				OTHER THAN SOUND LOGS
		NET SCALE BY DISPOSITION CATEGORY**				GROSS SCALE
		(1)	(2)		(3)	CULL PEELERS		OTHER CULLS
Name of Processor:
TOTALS
Name of Processor:
TOTALS
Name of Processor:
TOTALS
GRAND TOTALS

*Sound logs are defined as logs containing 33 1/3 percent of gross scale (50 percent of gross scale in the case of peeler blocks) in sound wood volume after deductions have been made for defect.
SCALED BY Company employee Scaling Bureau Other (specify)	SCALING METHODS Log scale rule used ___________________ Maximum length without taper _________ Taper allowance _____________________	**DISPOSITION CATERGORIES 1. Timber processed in the United States by purchaser 2. Timber sold to a third part for processing in the United States 3. Excepted and unprocessed timber sold or transported for export from the United States.
Comments

CERTIFICATION STATEMENT

I CERTIFY That the above statement is true and that it is to the best of my knowledge, a complete statement of the volume and disposition of all timber removed under said contract.

If Individual or Partnership, sign here:		If Corporation, sign here:
(Name of Firm)		(Name of Corporation)
(Signature of Signing Officer)		(Signature of Signing Officer)
(Business Address)		(Title)
(Signature of Signing Officer)		(Date)
(Business Address)
(Date)

If Purchaser is a Corporation, the following certificate must be executed by the Secretary or Assistant Secretary.
I,									,
certify that I am the			Secretary		Assistant Secretary of the Corporation named as purchaser herein, that
						who signed the certification was the		of
said corporation, that said certification was duly signed for and in behalf of said Corporation by authority of its
governing body, and is within the scope of its corporate powers.

[Corporate Seal]

NOTICE

The Privacy Act and 43 CFR 2.48(d) require that you be furnished with the following information in connection with the information requested by this form.

AUTHORITY: 43 CFR part 5420 permits collection of the information requested by this form.

PRINCIPAL PURPOSE: The BLM will use the information to determine the measurements and disposition of Federal timber.

ROUTINE USES: The BLM will only disclose this information in accordance with the Freedom of Information Act, the Privacy Act, and the provisions at 43 CFR 2.56(b) and (c).

EFFECT OF NOT PROVIDING INFORMATION: Submission of the requested information is necessary to obtain or retain a benefit. Failure to submit all of the requested information or to complete this form may result in delay or preclude the BLM’s approval of your purchase of Federal timber.

The Paperwork Reduction Act requires us to inform you that the BLM collects this information to determine the measurements and disposition of Federal timber. Submission of the requested information is necessary to obtain or retain a benefit. You do not have to respond to this or any other Federal agency-sponsored information collection unless it displays a currently valid OMB control number.

BURDEN HOURS STATEMENT: The public reporting burden for this form is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may submit comments regarding the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau of Land Management (1004-0058), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W., Mail Stop 401LS, Washington D.C. 20240.

Title 18 U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.

(Continued on page 7)