Terms and Conditions
1. The Bureau of Land Management (BLM) or Forest Service (FS)
(Agency) must approve any Surface disturbing activities in addition
to those approved in the NOI, such as route changes, placement of
magazines, towing with a tractor, blading, dozing, snow removal,
and vegetation removal. I must notify the Agency in writing of any
changes in the original proposal and have Agency approval in writing
for the changes before proceeding with them. Stacking source points
to avoid sensitive resources or areas does not require prior Agency
2. This NOI expires on , unless the
Agency extends it in writing before that date.
3. I understand that this NOI does not grant any exclusive right to the
described lands for geophysical exploration, or other purposes. The
land area described above is at all times subject to any other lawful
uses by the United States, its lessees, permittees, licensees, and
4. I must notify the Agency at least days, but no more than
days, prior to initiating the project and entering upon lands
managed by the Agency.
In the eld, each seismic crew must have a copy of the approved NOI
and its terms and conditions.
The Agency may suspend or terminate this NOI if there is a violation
of any of its conditions.
I must suspend operations when the operations may unnecessarily
damage the surface, such as when rutting would occur due to wet soil
I must indemnify the United States for any liability for damage to life
or property resulting from the occupancy or use of public lands under
I must take all reasonable precautions to prevent and suppress res.
The Agency may specify in writing the re prevention and reghting
equipment I need. At my expense, I must extinguish all res set or
caused as a result of operations under this NOI and must report all
res to the Agency.
I must diligently protect from unnecessary damage United States land
and property covered by this NOI. I must pay the United States for
any damage resulting from my or my agents’ or employees’ violation
of the terms of this NOI or any law or regulation applicable to the
I must store and handle powder magazines and explosives according
to the U. S. Bureau of Alcohol, Tobacco and Firearms standards (see
27 CFR Part 555). I must properly secure loaded shot holes.
I must complete shot hole plugging under Agency guidelines and the
guidelines of any other local, Federal, or State regulatory authority.
I must remove all materials and equipment I placed on the premises
and restore the site to the Agency’s satisfaction immediately after I
complete the project unless the Agency approves other arrangements.
I must le a Notice of Completion (NOC) Form 3150-5/2800-16a
within 30 days after completing operations and reclamation. If the
location of the project is dierent from that in the approved NOI,
I must submit a revised map with the NOC (1:24,000 scale, where
available), including source points.
15. I must pay to the United States $ per
according to the regulations.
16. This geophysical exploration project is subject to the attached
Conditions of Approval through
and Exhibits .
WARNING: If you purposely give false or misleading information, you may be ned $10,000, sent to prison, or both (see Title 18 U.S.C. 1001
statement on page 1).
I agree that I and my agents must conduct the geophysical exploration under all Federal, State, local laws, and applicable regulations, and I and my
agents must comply with this NOI and any attached terms and conditions.
Printed Name of Authorized Company Representative
Signature of Authorized Company Representative
Printed Name of Agency Signing Ocer
Signature of Agency Signing Ocer
Title of Agency Signing Ocer
AUTHORITY: This information is solicited under the authority of the Mineral Leasing Act (30 U.S.C. 181 – 287), Mineral Leasing Act for Acquired Lands (30 U.S.C.
341 – 359), Federal Land Policy and Management Act of 1976 (43 U.S.C. 1701 – 1782), and National Environmental Policy Act (42 U.S.C. 4321 – 4347). The BLM
collects this information in accordance with 43 CFR parts 3150 and 3160. The FS collects this information in accordance with 36 CFR part 228 and 251.
PURPOSE: The primary purpose for collecting this information is to facilitate the timely processing of your notice and inform you of the terms and conditions under
which geophysical exploration operations may be conducted.
ROUTINE USES: This information may be disclosed to agencies, organization or persons for authorized purposes as follows: (1) Documentation for public
information in support of notations made on land status, records for the management, and use of public lands and resource. (2) Information from the record and/
or the record will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions.
Additional information on authorized routine uses may be found in the published system of records notice, BLM-3, Mineral Lease Management—Interior, which may
be viewed at https://www.doi.gov/privacy/blm_notices
DISCLOSURE: Furnishing the information on this form is voluntary, however, failure to submit all or part of the requested information or to complete this form may
result in delay or result in revocation of your right to conduct geophysical exploration operations.
The Paperwork Reduction Act of 1995 requires us to inform you that:
The BLM/FS will use this information to process geophysical exploration notices.
Response to this request is required to obtain or retain a benet.
The BLM/FS would like you to know that 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 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 (1004-0162), 1849 C Street, NW, Room 2134LM, Attention: Information Collection Clearance Ocer,
Washington, D. C. 20240.
(BLM Form 3150-4 and FS Form 2800-16, page 3)
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