1998, 06-23 Fire InspectionWASHII GTOH STATE PATROL
FIRE PROTECTION BUREAU
STATEMENT OF D,EFFIICIIENCY & CORRECTIVE ACTION ACTION
FIRE AND LI - SAFETY INSPECTION: STATEMENT
FACILINAME TY (J l YP S C, D 6
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ZIP CQlpE7-(2INSPE
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AGENCY WSP -STATE FIRE MARSHAL
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ITEM
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STATEMENT OF DEFICIENCY
CODE OR WAC
REFERENCE
CORRECTIVE ACTION REQUIRED
CORRECTION REQUIRED
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THE DEFICIENCIES DESCRIBED ABOVE HAVE BEEN EXPLAINED TOA ME,
AND 1 AGREE TO MAKE CORRECTIONS NOT LATER THAN THE DATES
INDICATED.
SIGNATURE OF FACILITY MANAGER
REINSPECTION DATE
RIGHT OF APPEAL
PAGE / OF / PAGES
A facility aggrieved by the corrective orders of the State Fire Marshal or authorized representative may appeal to the State Fire Marshal within five
days of the order. If the State Fire Marshal confirms the order, it shall remain in force.
300o-460-470 12196 DISTRIBUTION: • White - State Fire Marshal • Yellow - License Agency • Pink - Facility • Gold - Inspector