Name of Range
*
Physical Address of Range:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
reply to email
Mailing address if different
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Range Point of Contact:
*
First Name
Last Name
Title
Cell Phone Number
*
-
Area Code
Phone Number
E-mail Address
*
example@example.com
Does Prevailing Wage Apply?
No
Davis-Bacon Act
Service Contract Act
Yes but unsure of type
Other
How did you hear about MT2?
Does your range have shower facilities? (in case MT2 field techs need to use)
Yes
No
Range Description: Range #1
Number of positions
Backstop type
Steel
Granulated Rubber
Other
Backstop size (feet): Depth of Media
Backstop size (feet): Width of Backstop
Backstop size (feet): Height of Backstop
Trap Manufacturer/Model
Ammo Type
Lead
Frangible
Mixed
Range Description: Range #2
Number of positions
Backstop type
Steel
Granulated Rubber
Other
Backstop size (feet): Depth of Media
Backstop size (feet): Width of Backstop
Backstop size (feet): Height of Backstop
Trap Manufacturer/Model
Ammo Type
Lead
Frangible
Mixed
Range Description: Range #3
Number of positions
Backstop type
Steel
Granulated Rubber
Other
Backstop size (feet): Depth of Media
Backstop size (feet): Width of Backstop
Backstop size (feet): Height of Backstop
Trap Manufacturer/Model
Ammo Type
Lead
Frangible
Mixed
Range Description: Range #4
Number of positions
Backstop type
Steel
Granulated Rubber
Other
Backstop size (feet): Depth of Media
Backstop size (feet): Width of Backstop
Backstop size (feet): Height of Backstop
Trap Manufacturer/Model
Ammo Type
Lead
Frangible
Mixed
Impact Area Dimensions
*Please provide digital photos of the following*
Access pathway (exterior of bldg. to trap)
Trap Access
Shooting Positions
Trap System Front
Trap System Back
Upload photos or sketches
*
Upload a File
Cancel
of
Range Access
Door #1 Width (include photo)
Door #2 Width (include photo)
Door #3 Width (include photo)
Hours of Access for Range Maintenance
Would MT2 need to access the range using stairs?
Yes
No
Lead Recovery History
Dates of range operation:
Date of Last Lead Recovery
Previous Provider
Pounds recovered last cleaning
Pounds recovered TWO cleanings ago
Annual pounds of recycled shells
Scrap amount paid for recycled lead
Services Requested
Lead Recovery
Annually
Bi-annually
Monthly
Quarterly
other
Brass Recovery
Annually
Bi-annually
Monthly
Quarterly
other
Filter Replacement
Annually
Bi-annually
Monthly
Quarterly
other
DCU Cleanout
Annually
Bi-annually
Monthly
Quarterly
other
Clean Range
Annually
Bi-annually
Monthly
Quarterly
other
Clean Areas Outside of Range
Annually
Bi-annually
Monthly
Quarterly
other
Range Waste Disposal
Annually
Bi-annually
Monthly
Quarterly
other
Add Additional Berm Media
Annually
Bi-annually
Monthly
Quarterly
other
Add Fire Retardant to Berm
Annually
Bi-annually
Monthly
Quarterly
other
Other Maintenance (List below)
Annually
Bi-annually
Monthly
Quarterly
other
Other Maintenance Needed
Would you be interested in MT2 performing an environmental review of your range Best Management Practices and providing a written report with recommendations for improvement?
Yes
No
In the future >6 months
Annually
Biannually
Quarterly
Monthly
Lead Recovery
Brass Recovery
Range Waste Disposal & Mgt.
Filter Replacement & Disposal
Add Additional Berm Media
Add Fire Retardant to Berm
OSHA/EPA Safety "pre-audit"
DCU Cleanout
Clean Range
Clean Areas Outside of Range
Other Maintenance
Range Assessment
Construction or Demolition
Range Upgrades
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