Wiatural Resources Forest Practices —="= Notice to Comply 4. Class of Forest Practice 5, Legal Subdivision T FP. App. No Region N/A cP. O class 1 class 1v Genoral SEK SEY, pice BA Class it O Class 1v Special | Te weep rg ay 6. Landowner 7. Timber Owner ‘8. Operator 5 A Saose as lO | Sane 26 Lo [Gi Stat Zip State Zi State Zip _| City ‘Under Authority of Ch. 76.09 RCW, Title 222 WAC— Name of Violator You are hereby given this NOTICE TO COMPLY in connection with violtlon(s), deviation(s), damagela), orPolenial damago(s) described below. 10. Damage Amount § Deviation from approved application 9. Reasons for © Authorizes Unauthorized 11, Damage Notice BE Violation of Forest Practices Act and/or Rules ‘Assessed by C1 immediate action is necessary to prevent continuation ‘of of to avoid matenal damage to a public resource 12, Description of violation(s), deviation(s), damage(s) or potential damage(s} em Se Le 78, Violation of WAC(S): TA, Violation Observed: 2 721 117. at {en ag) 222-39-02/ —— “Wo By Yr “amipm 222-30" OPANG) N45 sips servos in v8 must bo compe by = ; ale 222 -}0- 070 Va 16, You must complete the following steps: ! Ge bE fs fon Aakesifio~ ple tell StdowHed te He Jlp. fe 6, d, 17. The operator, timber owner or forest landowner has fiieen (15) calendar days from the Date of Service (Gox 19) to request a Brief ‘Adjucicative Proceeding betore the department to review this Notice to Comply. Appeal request must: be in writing, include signatures), and include the factual basis for the appeal and the issue to be adjudicated. (RCW 76.09.090(3), WAC 222-46-030(4), and WAC 332-08-215(3)) __ Region Oifice with any questions, phone ompliance Offer ‘oy = 22! Titd of Compliance Officer ‘23. Position No. + Prchrar Foe tle | 2920 Bi, (Office Use Only) Dat Copies sent to: — Oimber owner, tana Owner, rPOM CFP Coord, PHOther Agencies bf co EAT a he hinrh G, City Sr cY & Uy kh. Pate, Th < 7, Me. Die Yiniehagin Canay-Opwatr Fr—conptesoner =) owe 11116