| 2. Description of agency action: . . . . . . . . . . . . |
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| 3. Description of proposal (if not covered by (2)): |
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| 4. Location of proposal (a sufficient description should be given to locate the site, if any, but a complete legal description is not required): |
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| 5. Type of environmental review under SEPA (include name and date of any environmental documents): |
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| 6. Documents may be examined during regular business hours at (location, including room number, if any): |
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| 7. Name of agency, proponent, or applicant giving notice: |
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| 8. This notice is filed by (signature of individual and capacity in which the person is signing): |
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| . . . . . . . . . . . . | | Date . . . . . . . . . . . . |