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PUBLIC RECORD RELEASE REQUEST <br /> 1 . REQUEST RELEASE DATE <br /> 2 REQUESTING AGENCY PHONE NO. — <br /> 3. AGENCY ADDRESS h <br /> 4. INDIVIDUAL REQUESTING 'j�t�`yrO Q LSC rcxs�na�tle" PHONE NO\2 )8SH-2757 <br /> 5. INDIVIDUAL ADDRESS 298 I Aad �P [� lm0.�k eca Ca s33L <br /> FILE ADDRESS [� ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> Chs C� ` 1C1N�CCq t {�YC�SW.�A` NIT" <br /> �tu, cs_N� 5\\ \r`• +��% ;C� Ya.� V4\\lW�\\ \N bC�"�Q <br /> �cltiee,-, �vaa�� s,\she �;\ e \L��> ce��sr e�,•�i, <br /> f\\,c M'_CP c02.Q. Gs wq 5 qS <br /> Ce�De�e�, % �•��, ��L posse\�� <br /> *AS ERI C REQUESTED FOR PHOTOCOPYING <br /> SIGNATURE OF REQUESTING PARTY DATE <br /> LOCAL HEALTH DISTRICT USE ONLY <br /> PROJECTED RELEASE DATE <br /> SIGNATURE OF RELEASING OFFICIAL DATE ,I 6 'T v <br /> NAMES OF STAFF M ERS INVOLVED IN HE RELEASE AND MONITORING OF THE RECO -� cul <br /> IV JUN 9 1987 <br /> LTH <br /> LNv -OMENS: RLz <br /> FERNUT/ <br /> EH 00 14 4181 <br />