ORIGINATOR:
Fill in blocks 1 through 6.  Forward to:

Facilities Management Office
PO Box 5-549
Fort Richardson, AK 99505-0549
FAX : 428-6781

JANITORIAL, LAWN-CARE, OR SNOW PLOWING DEFICIENCY REPORTING FORM

1. Reported By: (Please Print) 2. Signature: 3. Date Noted:
4. Facility: 5. Phone Number: Date Received FMO:
6. Description of Deficiency: