Desktop Activity - Template

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Desktop Action ID:

Program Type:

Program ID:

Action Type:

Date:

Staff:

Compliance Determination:

Status:

Activity Report

Attached Files/Reports

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
9/1/2015	Reviewed Operator affidavit forms between sleepy hollow and Brett Mehman (for WS). All of the affidavit forms were photocopies and had not been "duley notarized" so the affidavit was denied. (Mr. Endris's affidavit (see below) appears to have been for WW service only.	TERRY JONES
8/31/2015	Review affidavits forms submitted by facility for WS/WW affidavit services from Bruce Endris. Denied the affidavit because the four forms they submitted were photocopies, not originals.	TERRY JONES

Comment:

Action Type	Date	Completed Date	Comment	Delete

Field Office Compliance - Desktop Activity