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sli4ffi Forest Service <br />U.S, DEPARTMENT OFAGRICULTURE <br />FS-rs00-19 (vEn. 0s/24) <br />OMB No. 0596-0217 <br />EXJr0Sl3ll2027 <br />I I.I. U.S. FOREST SERVICE SIGNATURE <br />Digitally signed by C. Andrew <br />C. AndfeW Q6ligll c"'i"rr <br />Dalet 2024.07 .25 16:06:37 -07'00' <br />(Sisnature of Sigratory Oflicial) <br />II.J. DATE <br />SIGNED <br />ll,M. NAME (typeorprint): ANDY CORIELL <br />I l.o. rtrt-E (type or print): Special Agent in Charge, <br />USDA Forest Service, Pacific Northwest Region <br />Law Enfbrcement & Investigations <br />12. G&A REVIEW <br />12.A. The authority and format of this modificntion have been reviewed and approved for signnture by: <br />MICHAEL <br />GADDIS <br />Digllally slgnod by MICHAEL <br />GADDIS <br />Dals: 2024.07.1 1 1o:4215 <br />-07'00' <br />MICHAEL K. GADDIS (24-LE-11061700-080 Mod. 001) <br />U.S, Forest Service Grants & As.reements Specialist <br />12.8. DATE <br />SIGNED <br />7111124 <br />Papenvork Roduction Act Slatemont <br />lndependence Avenue, SW, Room 404-W, Washinglon, D.C. 20250i and to the Offlce of Management and Budget, Papenrrork Reducllon Project (OMB# 0596-0217), 725 17th Street NW, <br />Washington, D.C. 20503, <br />program or activity ionducted or funded by USDA (not all bases apply to all programs). Remedies and complaint lillng deadllnes vary by program or incident. <br />available ln languages other than Engllsh. <br />(2) fax: (202) 690.7442; or (3) email: 4914.i4S@1@g!,9 <br />USDA isan squal opporlunity provlder, employer, and lender. <br />Tho PrivacyAct of 1974, 5 U.S.C, 552a and the Freedom of lnformation Act, 5 U,S.C. 552 govem the conlldentiality to be provided forlnformalion receivsd by the Forest Servlce. <br />Page 2 of 2