6. / 7. / 8. / 9. / 10. / 11. / 12. / 13. / 14. / 15. / 16. / 17. / 18.. / 19. / 20. / 21. / 22. / 23.
LEG NUMBER / USER
UNIT / USER
CODE / PROJECT, FIRE, FLIGHT OR RESOURCEORDER NAME OR NUMBER / FAA
IDENTIFIER / MISSION CODE / PAY CODE / PILOT
NAME(S) / PASSENGERS AND OTHER CREWMEMBERS / CARGO TYPE P,S,C,OR L / CARGO
LBS. / RETARDENT F, W, S, OR L / RETARDENT GALLONS / METER TYPE / TIME OR METER READING / ELAPSED TIME, HOURS AND HUNDREDS / RATE / LEG
TOTAL
FROM / TO / START / STOP
1
2
3
4
5
6
7
8
9
10.
24. ACCOUNTABILITY SUMMARY / 25. REMARKS / USER
UNIT / MISSION
CODE / PAY
CODE
NFC FUND CODE / UNIT / MGMT CODE / FY / BUDGET
OBJECT / AMMOUNT / 26 / OVERNIGHT
CHARGES / ON / LOCATION / # OF PEOPLE / /
2541 / 27. / SERCICE TRUCK
CHARGES / ST / MILES
2541 / 28. / OTHER CHARGES / OH / DESCRIBE
2541 / 29. / OTHER CHARGES / CB / DESCRIBE
2541 / 30. / SUBTOTAL
2541 / 31. / EXCISE TAX / TX / PAX OR CARGO OVER 6000 WEIGHED
2541 / 32 / TOTAL OF ALL CHARGES
2541 / 33. NAME OF GOVT OFFICIAL
PHONE #
34. I CERTIFY THAT THE SERVICES LISTED ABOVE HAVE BEEN RECEIVED – SIGNATURE AND TITLE OF FOREST SERVICE OFFICIAL / 35. I CERTIFY THAT THE SERVICES LISTED ABOVE HAVE BEEN PROVIDED-SIGNATURE AND TITLE OF VENDOR AGENT
USDA – FOREST SERVICE FLIGHT REPORT FS 6500-122 (06/95)PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE