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RESOLUTION
RE: AUTHORIZATION FOR THE WELD COUNTY ATTORNEY TO PROCEED WITH
LEGAL ACTION AGAINST DONALD AND SANDRA WILLIAMS AND TAMMY
SWARTZ FOR VIOLATION OF THE WELD COUNTY ZONING ORDINANCE
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, Donald and Sandra Williams and Tammy Swartz, VI #9600082, are
allegedly in violation of the Weld County Zoning Ordinance, and
WHEREAS, despite efforts by the Planning staff to resolve said matter, the violation has
not been corrected, and
WHEREAS, on the 13th day of August, 1996, a public hearing was held before the
Board of County Commissioners for the purpose of hearing testimony relating to said violation,
and
WHEREAS, Tammy Swartz, tenant, was present at said hearing, and
WHEREAS, the Board of County Commissioners deems it advisable to delay referral of
said violation to the Weld County Attorney's Office for a period of 45 days to allow adequate
time for the property owners and tenant to bring the subject property into compliance and for an
inspection of the property by the Department of Planning Services staff, and
WHEREAS, the Board deems it advisable to proceed with legal action against the above
named individuals without further Board action if the subject property is not brought into
compliance within 45 days.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that if said violation still exists on October 1, 1996, the Weld County
Attorney be, and hereby is, authorized to proceed with legal action against Donald and Sandra
Williams and Tammy Swartz to remedy the violation of the Weld County Zoning Ordinance, and
any other persons occupying the properties, any persons claiming an interest in the properties,
and any persons acting in active concert with the identified parties.
ee. ; /at J C 1�: GJ/[.l.//tns/Su1/9ee'T2 961389
PL0824
VIOLATIONS - VI #9600082 - DONALD AND SANDRA WILLIAMS AND TAMMY SWARTZ
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 13th day of August, A.D., 1996.
BOARD OF COUNTY COMMISSIONERS
"'�� WELD COUNTY, COLORA O ty i
: ' Barba a J. Kirkmeyer, hair
ISGI e` et jI ntyClerk to the Board K
Georg E. Baxter, Pro-Tem
Sai.OUNec
�rrtDeputy Clerk 4, the Board FxCI ISFn
Dale K. Hall
APP ED AS TO M:
Constance L. Harbert
my Attorn y 4(>14.
W. H. Webster
961389
PL0824
DATE: August 8, 1996
VIOLATION NUMBER: VI-9600082
NAME: Donald and Sandra Williams/Tammy Swartz
ADDRESS: 60300 Coyote Canyon, Anza, CA 92539/P.O. Box 691, Ft. Lupton, CO 80621
LEGAL DESCRIPTION: Lot 2, Block 30, 2nd Filing, Aristocrat Ranchettes, Weld County,
Colorado
PARCEL NUMBER: 130927219007
CASE SUMMARY:
May 10, 1996 Complaint received and assigned to Julie Chester, Zoning Compliance Officer.
May 10, 1996 Property inspected by Julie Chester. The property is not in compliance.
May 22, 1996 Five day compliance encouragement letter sent to property owner and tenant.
May 31, 1996 Property inspected by Julie Chester. The property is not in compliance. Met
with the tenant at the time of inspection.
June 4, 1996 Zoning Violation notice sent to property owner and tenant.
July 9, 1996 Property inspected by Julie Chester. The property is not in compliance.
July 31, 1996 Letter sent to the property owner and tenant indicating that they were
scheduled for a meeting with the Board of County Commissioners.
The noncommercial junkyard is still located on the property, therefore is a violation of Sections
31.2 and 31.3.9 of the Weld County Zoning Ordinance. To bring the property into compliance
the noncommercial junkyard must be removed from the property or screened from all adjacent
properties and public rights of way.
The Department of Planning Services also recommends that the County Attorney authorize
legal action against any other persons occupying the properties, any persons claiming an
interest in the properties, and any persons acting in active concert with the identified parties.
961389
PERMITS Id: MISC120 Keyword: UACT User: JCHESTER 08/13/96
Additional Notations for Inspection item: 00400 Violation
Permit No: VI-9600082 Owner: WILLIAMS DONALD J & SANDRA T
Status : ISSUED Address : 15166 CAROLINE AV ARI
Line Insp. Date Text
1 08/12/96 THE PROPERTY WAS INSPECTED TO DETERMINE COMPLIANCE WITH THE
2 08/12/96 WELD COUNTY ZONING ORDINANCE, SECTIONS 31 . 2 AND 31 . 3 . 9 . THE
3 08/12/96 PROPERTY IS NOT IN COMPLIANCE AT THIS TIME . THERE ARE
4 08/12/96 SEVERAL DERELICT VEHICLES AND SOME OTHER MISCELLANEOUS ITEMS
5 08/12/96 LOCATED ON THE PROPERTY. NO ONE WAS HOME AT THE TIME OF
6 08/12/96 INSPECTION AND I COULD NOT GET TO THE FRONT DOOR BECAUSE OF
7 08/12/96 A LOCKED GATE AND A DOG. TO BRING THE PROPERTY INTO
8 08/12/96 COMPLIANCE THE NONCOMMERCIAL JUNKYARD MUST BE REMOVED OR
9 08/12/96 SCREENED FROM ALL ADJACENT PROPERTIES AND PUBLIC RIGHTS OF
10 08/12/96 WAY. A VIDEO WAS TAKEN AT THE TIME OF INSPECTION FROM THE
11 08/12/96 ROAD RIGHT OF WAY.
12 08/12/96 JULIE CHESTER, ZONING COMPLIANCE OFFICER
Enter Option: A=Add, C=Change, D=Delete, I=Inspect
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Comment Added O.K.
961389
DEPARTMENT OF PLANNING SERVICES
PHONE (970)353-6100,EXT.3540
FAX (970)352-6312
C. WELD COUNTY ADMINISTRATIVE OFFICES
1400 N. 17TH AVENUE
GREELEY, COLORADO 80631
COLORADO
July 31, 1996
Donald and Sandra Williams
60300 Coyote Canyon Road
Anza, CA 92539
Subject: VI-9600082 Legal Description: Lot 2, Block 30, 2nd Filing, Aristocrat Ranchettes,
Weld County, Colorado
Dear Mr. and Mrs. Williams:
The property referenced above remains in violation of the Weld County Zoning Ordinance. 1
have scheduled a meeting with the Board of County Commissioners on August 13, 1996 at
2:00 p.m. to consider the Zoning Violations occurring on the property. This meeting will take
place in the County Commissioners' Hearing Room, first floor, Weld County Centennial Center,
915 Tenth Street, Greeley, Colorado. It is recommended that you or a representative be in
attendance to answer any questions the Board of County Commissioners might have about the
violation.
The Department of Planning Services' staff will be recommending that the Board of County
Commissioners authorize the County Attorney to proceed with legal action to remedy the
violation. Our records indicate that you were made aware of the nature of the violation, the
action necessary to correct the violation, and that you were given sufficient time to remedy the
violation.
If you have any questions concerning this matter,please call me.
Sincerely,
Julie Chester
Zoning Compliance Inspector
pc: VI-9600082'
Tammy Swartz, P.O. Box 691, Ft. Lupton, CO 80621
961389
PERMITS Id: MISC120 Keyword: UACT User: JCHESTER 07/11/96
Additional Notations for Inspection item: 00400 Violation
Permit No: VI-9600082 Owner: WILLIAMS DONALD J & SANDRA T
Status : ISSUED Address : 15166 CAROLINE AV ARI
Line Insp. Date Text
1 07/09/96 THE PROPERTY IS STILL IN VIOLATION OF SECTIONS 31 . 2 AND
2 07/09/96 31 .3 . 9 OF THE WELD COUNTY ZONING ORDINANCE. THERE ARE
3 07/09/96 SEVERAL DERELICT VEHICLES AND OTHER MISCELLANEOUS JUNK
4 07/09/96 LOCATED ON THE PROPERTY. TO BRING THE PROPERTY INTO
5 07/09/96 COMPLIANCE THE NON-COMMERCIAL JUNKYARD MUST BE REMOVED OR
6 07/09/96 SCREENED FROM ALL ADJACENT PROPERTIES AND PUBLIC RIGHTS OF
7 07/09/96 WAY.
8 07/09/96 JULIE CHESTER, ZONING COMPLIANCE OFFICER
ce,(4,,- a
Enter Option: A=Add, C=Change, D=Delete, I=Inspect
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Comment Added O.K.
961.389
DEPARTMENT OF PLANNING SERVICES
PHONE (303)353-6100,EXT.3540
WI D
FAX (303)352-6312
C
WELD COUNTY ADMINISTRATIVE OFFICES
1400 N. 17TH AVENUE
COT "OR /�L1 DO GREELEY,COLORADO 80631
JJ WELD COUNTY
ZONING VIOLATION NOTICE
June 4, 1996 Violation Number: VI-9600082
Donald and Sandra Williams
60300 Coyote Canyon Road
Anza,CA 92539
Legal Description : Lot 2, Block 30, 2nd Filing,Aristocrat Ranchettes, Weld County,Colorado
The uses on the above described property are being considered as a zoning violation of Section 31.2 and,
31.3.9 of the Weld County Zoning Ordinance, This is not a use allowed by right in the Agricultural zone
district.
The violation can be corrected by removing the derelict vehicles,car parts and any other miscellaneous
item considered part of the non-commercial junkyard or screening all these items. If screening is to be
used, a detailed screening plan must be submitted to and approved by the Department of Planning
Services staff prior to installation.
It is the intention of this office to assist and cooperate with you without imposing undue hardships;
however,we have no discretion in this matter if you fail to correct this violation. You have 30(Thirty)
days from June 4, 1996 to correct this zoning violation.Failure to do so will result in this office
scheduling the violation before the Board of County Commissioners to consider whether to refer the
violation to the County Attorney's office for legal action.
Any information you have that may help to resolve this matter will be helpful. This office is ready to be
of any assistance in clarifying or answering questions concerning this matter.Please call or write the
Department of Planning Services'office.
Sincerely,
Julie Chester
Zoning Compliance Officer
pc: VI-9600082
Tammy Swartz,PO Box 691,Ft. Lupton,CO 80621
961399
PERMITS Id: MISC120 Keyword: UACT User: JCHESTER 06/04/96
Additional Notations for Inspection item: 00400 Violation
Permit No: VI-9600082 Owner: WILLIAMS DONALD J & SANDRA T
Status : COMPLNT Address : 15166 CAROLINE AV ARI
Line Insp. Date Text
1 05/31/96 THE PROPERTY WAS INSPECTED TO DETERMINE COMPLIANCE WITH
2 05/31/96 SECTIONS 31 . 2 AND 31 . 3 . 9 OF THE WELD COUNTY ZONING
3 05/31/96 ORDINANCE. THE PROPERTY IS NOT IN COMPLIANCE AT THIS TIME .
4 05/31/96 THERE ARE SEVERAL DERELICT VEHICLES, CAR PARTS AND OTHER
5 05/31/96 MISCELLANEOUS ITEMS THAT ARE CONSIDERED PART OF A NON-
6 05/31/96 COMMERCIAL JUNKYARD. TO BRING THE PROPERTY INTO COMPLIANCE,
7 05/31/96 THE NON-COMMERCIAL JUNKYARD MUST BE REMOVED FROM THE
8 05/31/96 PROPERTY OR BE TOTALLY SCREENED FROM ALL ADJACENT PROPERTIES
9 05/31/96 AND PUBLIC RIGHTS OF WAY. IF SCREENING IS TO BE USED, A
10 05/31/96 DETAILED SCREENING PLAN MUST BE SUBMITTED AND APPROVED BY
11 05/31/96 THE DEPT. OF PLANNING SERVICES PRIOR TO INSTALLATION.
12 05/31/96 JULIE CHESTER, ZONING COMPLIANCE OFFICER
Enter Option: A=Add, C=Change, D=Delete, I=Inspect
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Comment Added O. K.
961.389
Y .;
a 1 .1 S
O
i . DEPARTMENT.OF PLANNING SERVICES
PHONE (303)353-6100,EXT.3540
FAX (303)352-6312
I Co
WELD COUNTY ADMINISTRATIVE OFFICES
AT 1400 N. 17T H AVENUE
lC. Lot'ADo GREELEY,COLORADO 80631
i
May 22, 1996
Donald and Sandra Williams
60300 Coyote Canyon Road
Anza, CA 92539
Subject: VI-9600082 Legal Description: Lot 2,Block 30,2nd Filing Aristocrat Ranchettes,
Weld County, Colorado
Dear Mr. and Mrs. Williams:
It has come to the attention of the Department of Planning Services' staff that the uses on your
property(15166 Caroline Avenue, Ft. Lupton) may not be in compliance with the Weld County
Zoning Ordinance. The potential noncompliance with the zoning ordinance is a non-commercial
junkyard consisting of used building materials,tires, a car hood,auto parts and other
miscellaneous items located on the property.
Please call me within five working days of the date of this letter to review the concerns with me.
Sincerely,
oh.- C
Julie Chester
Zoning Compliance Officer
pc: VI-9600082
SERVICE,TEAMWORK.INIEQtrrr,QUALITY
961.359
PERMITS Id: MISC120 Keyword: AACT User: JCHESTER 05/22/96
Additional Notations for Inspection item: 00400 Violation
Permit No: VI-9600082 Owner: WILLIAMS DONALD J & SANDRA T
Status : COMPLNT Address : 15166 CAROLINE AV ARI
Line Insp. Date Text
1 05/10/96 THE PROPERTY WAS INSPECTED TO DETERMINE COMPLIANCE WITH
2 05/10/96 SECTIONS 31 . 2 AND 31 . 3 . 9 OF THE WELD COUNTY ZONING
3 05/10/96 ORDINANCE. THE PROPERTY IS NOT IN COMPLIANCE AT THIS TIME.
4 05/10/96 THERE IS A NON-COMMERCIAL JUNKYARD CONSISTING OF BUILDING
5 05/10/96 MATERIALS, TIRES, A CAR HOOD AND AUTO PARTS . TO BRING THE
6 05/10/96 PROPERTY INTO COMPLIANCE THE NON-COMMERCIAL JUNKYARD MUST BE
7 05/10/96 REMOVED FROM THE PROPERTY OR BE TOTALLY SCREENED FROM ALL
8 05/10/96 ADJACENT PROPERTIES AND PUBLIC RIGHTS OF WAY. IF SCREENING
9 05/10/96 IS TO BE USED TO CONCEAL THE NON-COMMERCIAL JUNKYARD, A
10 05/10/96 DETAILED SCREENING PLAN MUST BE SUBMITTED TO AND APPROVED BY
11 05/10/96 THE DEPARTMENT OF PLANNING SERVICES STAFF PRIOR TO
12 05/10/96 INSTALLATION. JULIE CHESTER, ZONING COMPLIANCE OFFICER
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Comment Added O. K.
961.389
Permit No VI-9600082 DATA SHEET Page: 1
COMPLAINT 05/22/96 08:43
Data: Full Description
Description: NCJY LOCATED ON PROPERTY
Data: Process Tables
Screen No: 01
Base Information
Parcel No: 1309 27 219007 000001
Owner: WILLIAMS DONALD J & SANDRA T
Status: COMPLNT Written By: JAC Sec/Twn/Rng: 27 02 66
Description: NCJY LOCATED ON PROPERTY
Location: 15166 CAROLINE AVENUE, ARISTOCRAT
Zoning Dist: AGRICULT
App Type: VI (BCV=BLDNG VIO, VI=ZONING VIO, WCV=WELD VIO ^bcv + vi^)
Class Code: VI-2
Noncommercial Junkyard
Complaint: 05/22/1996 Init: JAC NO VI: 00/00/0000 Init:
5 Day Letter: 05/22/1996 Init: JAC
Issued: 00/00/0000 Init:
Inspection: 00/00/0000 Init:
BCC Vio: 00/00/0000 'nit:
Court: 00/00/0000 Init:
Closed BCV: 00/00/0000 [nit: Closed VI: 00/00/0000 'nit:
Screen No: 02
Zoning Information
Parcel No :1309 27 219007 000001
Legal Descr:2AR30-2 IMPS ONLY MN L2 830 2ND ARISTOCRAT RANCH HILLCREST 7
Owner Name :WILLIAMS DONALD J & SANDRA T Date:00/00/0000 Verified:
Setbacks N: S: E: W: Reg by Zoning Sec Twn Rng:27 02 66
Notes:
Zoning Dist: Acres .00
•* 1=Yes, 2=No, 3=Appr/Cond Met, 4=Appr/Cond Not Met **
Legal Lot y Site Plan Review SPR
Prior to Zoning Yr I Board of Adjustment BOA
a 80 Acres q Non-Conforming Use NCU
Rec Exemption RE 9 Flood Hazard Dev FHDP
Sub Exemption SE 9 Geological Hazard GHP
Use Spec Review USR 9 Accessory Dwelling ZPAD
Planned Unit Dev PUD q
Subdivision S 9
Change of Zone COZ 1 Violation VI
Data: People
OWNER WILLIAMS DONALD J & SANDRA T 05/22/96
60300 COYOTE CANYON RD
AN2A CA
92539 -
961389
Permit No VI-9600082 DATA SHEET Page: 2
COMPLAINT 05/22/96 08:43
Data: Conditions
Data: Comments
Data: Inspections
Item: 00404 TELEPHONE CALL Dept: Division:
Item: 00405 LETTER Dept: Division:
05/22/1996 JAC Action: VI 5 DAY LETTER SENT Time: 00:00
Item: 00400 SITE INSPECTION Dept: Division:
05/10/1996 JAC Action: VI INITIAL INSPECTION Time: 00:10
Data: Approvals
Item: 00001 Building Department Dept: BUILDING Division:
Item: 00002 Planning Department Dept: PLANNING Division:
Data: Locks, Holds, Notices
Data: Addresses
15166 CAROLINE AV ARI
05/22/96
Data: Parcels
130927219007000001 / /
9►61299
PERMITS Id: ASSR100M Keyword: @ASSRD User: JCHESTER 05/22/96
Parcel General Information Maintenance
P6&&&&&&&&&&&&&&&&&&&&&&&&6&&&&&6&&&&&6&&&66&&&&&6&&&6&&&&&&66&&&&&&6&&&&&&&&&&£
❑ General Parcel Data Maint - Action: Inspect a Record a
uaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaN
a Parcel No: 1309 27 219007 000001 Rg Ts Sec : 660227 ❑
a
a
❑ Status : A Active Retired (Y/N) : N ❑
a Street Address : 15166 Dir: St : CAROLINE AV City: ARI ❑
❑ Situs Location: 15166 CAROLINE AV ARISTOCRAT a
a Legal Desc : 2AR30-2 IMPS ONLY MH L2 B30 2ND ARISTOCRAT RANCH ❑
a Acres : . 00 ❑
a X-COORD: a
a Y-COORD: a
❑ Tax Rate Area: 0820 a
a Assr Use Code : 0083589 Assessed/Exempt : a
❑ Pub Owned(Y/N) : N a
a Primary Owner: WILLIAMS DONALD J & SANDRA T Phone : a
a Mailing Addr: 60300 COYOTE CANYON RD a
❑ ANZA CA ❑
a Zip: 92539 a
a Contract Owner: Percent/Ownership: . 00 ❑
/ p:
A6&&&&&&&&6&6&&&6&&&&&&6&6&&6&6&&&&&666&&&&&666&&6&&&&e6E&&2&&&&&E&&&&&&6&&&&&&Y
*** Press any key to continue ***
961383
PERMITS Id: ASSR100D Keyword: @ASSRD User: JCHESTER 05/22/96
Parcel Legal Description Maintenance
eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee£
❑ Parcel Legal Description - Action: Inspect Page : 1 ❑
uaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaN
❑ 2AR30-2 IMPS ONLY MH L2 B30 2ND ARISTOCRAT RANCH ❑
❑ HILLCREST 74-0259437H ❑
LAND WILLIAMS DONALD J & SANDRA T ❑
❑ 15166 CAROLINE AV ARISTOCRAT ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
❑ ❑
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❑ ❑
. .. .. . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . .. .. .. .. .. . .. .. .. .. .. .. .. . .. ..
aee66eeeeeeeee6eeeeeeeeeeeeeeee6eeeeeeeeeeeeeeeeeeeeeeeee6eeeeeeeeeeeeeee6eeeeeY
❑ Parcel : 1309 27 219007 000001 Use : 0083589 Owner: WILLIAMS DONALD J & SANDR ❑
❑ Situs : 15166 CAROLINE AV ARISTOCRAT Acres : ❑
❑ Legal : 2AR30-2 IMPS ONLY MH L2 B30 2ND ARISTOCRAT RANCH ❑
&6e66eeeeeeeeee666eee6eeeeeee6eeee6eeeeeeeeee6ee6eeeeeeeee6eeeeeeeeeeeeee6eeee6Y
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961.389
PERMITS •
Id: MISC301 Keyword: @ASSRD User: JCHESTER 05/22/96
User Defined Data Fields for Parcel No: 1309 27 219007 00000
Oaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaat
° Parcel No: 1309 27 219007 000001 0
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaai
eec,Additional USER DEFINED Assessor Parcel InformationoeeeeeeeeecScreen No: 010£
n
❑
❑ Parent Parcel No 055322000005 ❑
❑ Book No. ❑
❑ Reception No. ❑
❑ Document Type ❑
❑ Ownership Type ❑
❑ Recording Date / / ❑
❑ Zoning Dist ❑
Legal Lot ❑
❑ Prior To Zoning ❑
❑ Prior To Zoning Year ❑
❑ > 80 Acres ❑
❑ Recorded Exemption ❑
❑ Rec Exemption Permit ❑
❑ Rec Exemption Approva
❑
❑
aeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeY
Enter Screen Number: 2 or ESC=Exit Table Processing
•
961.3E39
(iii t (;%N.) i
DEPARTMENT OF PLANNING SERVICES
W111111 �. V%crn)gz
COMPLAINT REPORT
COLORADO
juvt-ti Al
ONING COMPLAINT Comp! int Initiated by:
o BUILDING CODE COMPLAINT y 6- 6 aff o Citizen o Other
o LEGAL DESCRIPTION: tY
VIOLATION ADDRESS: / Si& r�(/
/iyio Q
Parcel# i 307-7Y°V l ov JI �/� ATTACH OPY OF E
Property Owner's Name: 7L/L� r�°� A IFP n�
Property Owners Address: ep v D J C7� 4
Tenant's Name and Mailing Address: /av12 / 5.// �5 �� �' t%tK�/
NATURE OF COMPLAINT: /1 ' r /at•�l , / / A „ \
/,Ltd q t c / Gt LZcf C u O�GL.po
Zoning Complaint Referred To: C``Slums" Date: VA"
Building Code Complaint Referred To: Date:
Case Assigned To: C \f-L --L / Date: 6/4(/
9C-'
ACTION OF INVESTIGATOR: Date of Inspection: 5-bieV ,6
Inspection of property indicates:
❑ No violation of the Weld County o Zoning I ❑Building Code Ordinance
Referred to: on
❑ wolation of the Weld County o Zoning / ❑ ilding Cogj Ordinance f�
iolations of the following Sections of the-a'Loning O/ a" ��' 3'
❑Building Code Ordinance
ACTION ON COMPLAINT: o No Action Taken/No Violation iolation to fd/-
Date Date , D/`//" •
CASE REVIEWED BY SUPERVISOR - Date
SUPERVISOR'S COMMENTS
NOTE: Attach all pertinent information and facts disclosed by investigation to this form.
9613E39
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