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' 1 <br /> PUBLIC RECORD RELEASE REQUEST <br /> 1 , REQUEST RELEASE DATEi L%y Z , 1989 <br /> 2. REQUESTING AGENCY I�T�f m_ 51ecift-k. Ivnc PHONE NO. (oz)- 82 -1200 <br /> 3. AGENCY ADDRESS <br /> 4. INDIVIDUAL REQUESTING M0-y +PHONE NO. -q2z) - & zq-I zoo <br /> 5. INDIVIDUAL ADDRESS <br /> FILE ADDRESS ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> gSS uJ. 4a m uta4 (� l� in4 ReQoft��rvni k S 2- �r+viryr. .nenb 5i bP <br /> a <br /> �cpQft Q���Wr�C�C'P-T Jt ,�55eS5vnen'�, <br /> *ASTERISK MCA <br /> REQUESTED FOR PvIOTOCOPYING <br /> SIGNATURE OF REQUESTING PARTY MCA DATE <br /> LOCAL HEALTH DISTRICT USE ONLY <br /> PROJECTED RELEASE DATE <br /> SIGNATURE OF RELEASING OFFICIAL _ --DATE <br /> NAMES OF STAFF MEMBERS INVOLVED IN THE RELEASE AND MONITORING OF THE RECORDS . <br /> iN nO 14 <br />