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PUBLIC RECORD RELEASE REQUEST <br /> 1. REQUEST RELEASE DATEW <br /> _ ee P-' o F re b rq <br /> 2. REQUESTING AGENCY PHONE NO. <br /> 3. AGENCY ADDRESS <br /> 4. INDIVIDUAL REQUESTING _WWI, "4er- PHONE No&161 q7,?- -7 � <br /> S. INDIVIDUAL ADDRESS V)yA. L , L" 11 ler (Assoc 2 ZO l. , t,4 15TA DP <br /> SA+c2A�EU 'To C4 40737 S <br /> FILE ADDRESS ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> [448 S 4A+UJ R D (r LJ w� est- 1126/7 Vod 11eeu� r 47 vn - <br /> S�tic{C� rrv� f 1-C r r a:ltvvi oaf <br /> ra5ulfs of I��b s1 , i2d <br /> PAYMENT <br /> RECEIVED <br /> J AN 2 9 T993 <br /> PUBLIC HEALTH SERVICES <br /> ENVIROISIAGISITAI I, <br /> ASTERISK ITEMS R Q TED FOR PHOTOCOPYING / <br /> SIGNATURE OF REQUESTING PARTY � DATE lZ� 7 <br /> PUBLIC HEALTH SERVICES 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- <br /> RECORDS. <br /> EH 00 14 <br />