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Pt-,LIC RECORD RELEASE REQUES <br /> 1 . REQUEST RELEASE DATE -2 - I9 '88 i <br /> 2 REQUESTING AGENCY -►� c ti`b'N=E r��NCz PHONE NOI /2z 3 <br /> 3. AGENCY ADDRESS LjjA L6,4L4 *-- C.� <br /> 1. INDIVIDUAL REQUESTING " (CIZ A PHONE NO( ��� <br />�. <br /> INDIVIDUAL ADDRESS <br /> FILE ADDRESS ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> ("Tl- <br /> f t4G lJ F ur4t c�. IVWC5 «e'l �-� p✓vim crc; wL <br /> r <br /> J e <br /> J <br /> •AS ISK IT MS RE STED POR PHOTOCOPYING <br /> GNATURE OF REQUESTING PARTY ( DATE <br /> CAL HEALTH DISTRICT USE ONLY <br /> OJECTED RELEASE DATE <br /> GNATURE OF RELEASING OFFICIAL <br /> - , DATE <br /> MES OF STAFF MEMBERS INVOLV IN THE RELEASE AND MONITORING OF THE RECORDS. <br />