WDFW Brood Document Change Form by d7qPyB

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									                            Permanent Brood Document Change Form
Agency                                         Facility
Species                                   Race                                                  Stock

What is first brood year affected?

Has this proposed change been discussed and pre-approved by affected co-managers in the region? (Y/N)
             Note: Please do not complete or submit forms that have not been pre-approved.

              _ Add new program, eggtake, transfer, or plant to the future brood document
   Pick
              _ Change numbers for eggtake, transfer, plant as listed in the future brood document
   one        _ Delete existing program, eggtake, transfer, or plant in the future brood document
Explanation
    of
  intent



Activity as listed in FBD **:                    ** If change in one category affects other categories, please note all changes.
                  Target         Fish/Eggs                                                                                 Size
                                                     Origin/Facility            Destination/Location           Date
                 Numbers        Eyed/Green                                                                                 (fpp)
Eggtake:                        Eggs
Transfer:



Planting:



Footnotes from FBD:


Proposed activity**:                               ** If change in one category affects other categories, please note all changes.
                 Target          Fish/Eggs                                                                                    Size
                                                       Origin/Facility             Destination/Location          Date
                Numbers         Eyed/Green                                                                                    (fpp)
Eggtake:                        Eggs

Transfer:




Planting:




Footnotes for FBD:




       Name of Requester:                Agency:                    Contact Information:                   Date of Request:
                                                           Email:
                                                           Phone Number:


                       Please send/return to Kelly Henderson, WDFW Science Division for routing
                             (hendeksh@dfw.wa.gov, 360-902-2684) Revised 12/04/06
                           Permanent Brood Document Change Form Instructions
This form is for a permanent change to the Future Brood Document. If you are proposing a change that would also affect the current
brood year you must also fill out an In-Season Brood Document Change Form. Be sure that this form is filled out completely
before submittal or it will be returned for corrections before routing.

Agency: Type or write in all affected agencies by the proposed change

Facility: Type or write in all affected facilities by the proposed change

Species: Type or write in the affected species

Race: Type or write in the affected race

Stock: Type or write in the affected stock

What is the first brood year affected? : Type or write in the first brood year that the change will affect

Has this proposed change been discussed and pre-approved by affected co-managers in the region? Please
answer this with YES or NO if your changes pertain to any area of the state that has co-management. Forms that do
not have this field filled in, will not be processed further until affected co-manager approval has been achieved.

Pick the type of change being proposed: Place an X next to the applicable type of change

Explanation of Intent: Type or write a brief explanation of your intent with the proposed change

Activity as listed in FBD: Type or write the activity in this section as it reads in the Brood Document, including all
information that pertains to the changes being proposed

         Eggtake: List the current eggtake number if applicable to proposed changes
         Transfer: List the number, Life stage, the Origin/Hatchery of the transfer, the Destination/Hatchery of the transfer, the
         Date (Month/Year) and Size (fish per pound)
         Planting: List the Number, Life stage, the Destination/Location (including WRIA if applicable), Date
         (Month/Year) and Size (fish per pound) for each release
         Footnotes from FBD: List any footnotes in the Future Brood Document that may pertain to the proposed change

Proposed Activity: Type or write all of the proposed changes in this section

         Eggtake: List the number if applicable to proposed changes
         Transfer: List the number, Life stage, the Origin/Hatchery of the transfer, the Destination/Hatchery of the
         transfer, the Date (Month/Year) and Size (fish per pound)
         Planting: List the Number, Life stage, the Destination/Location (including WRIA if applicable), Date
         (Month/Year) and Size (fish per pound) for each release
         Footnotes: List any new or revised footnotes in the Future Brood Document that may pertain to the proposed
         change

Name of Requester: Type or write your First and Last name

Agency: Type or write the name of the agency for which you work

Contact Information:
        E-mail: Type or write your e-mail address for contact for questions regarding your request
        Phone Number: Type or write in your contact telephone (or cell phone) number at which you can be reached
        regarding questions to your request

Date of Request: Type or write the date of the request


             Please send the completed form to Kelly Henderson at Washington State Department of Fish and Wildlife
                                        hendeksh@dfw.wa.gov or by fax at 360-902-2153.

								
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