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-JBLIC RECORD RELEASE REQUEr- <br /> 1 , REQUEST RELEASE DATE�,7- <br /> 2 REQUESTING AGENCY — PHONE NO.�Qy QZj}� <br /> 3. AGENCY ADDRESS_ (� . R <br /> st Tf�� f� <br /> 4. INDIVIDUAL REQUEST INGKZ:: `64ljk) 'Zpl F7?� I PHONE NO. <br /> S. INDIVIDUAL ADDRESS <br /> FILE ADDRESS ITEM REQUESTED GATE PURPOSE OF REQUEST <br /> X235 �r nitir2r b I r E <br /> *ASTERISK ITEMS REQUESTED POR PHOTOCOPYING <br /> IGNATURE OF REQUESTING PARTY DATE <br /> OCAL HEALTH DISTRICT USE ONLY <br /> ROJECTED RELEASE DATE <br /> IGNATURE OF RELEASING OFFICIAL DATE <br /> Um OF ST F MEMBERS INVOLVED IN THE RELEASE AND MONITORING OF THE RECORDS. <br /> otic <br /> PAYMENT <br /> RECEIVED . y . <br /> u N T-i6Pc�— <br /> JUN 11-ioo <br /> ENVIROmE^TAE H;ALTH <br /> fWv*0NMENTAL HWt---- TERMn7SEr%vI%-,"5 <br /> 00 14 PERMITISERVICES 4/81 <br />