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DETAILED REVIEW CHECK 1-18t ' <br /> Pogo 3 <br /> Clalmant Name: <br /> COMPLIANCE DOCUMENTATION <br /> DATE ACTIONIRESPONSE <br /> A,4 - / <br /> i/ yrU J l L!✓. �.L/�. <br /> M <br /> F e f exf <br /> U <br /> G s r <br /> Continued on Reverse a <br /> CONFIRMATION OF CORRECTIVE ACT70N COMPLIANCE <br /> Claimant in Corrective Action Compliance l0?.� D a <br /> Claimant NOT in Corrective Action Compliance at the Time of this Review- 90 Day Letts equtred N <br /> ❑ Claimant NOT in Corrective Action Compliance • Recommend Rejection <br /> 46 Q �� zp <br /> LEA GENCY SIGNATURE DAft <br /> O-a -77 <br /> CLAIMS REVIEWER SIGNATURE DATE <br /> USTCF025.DET (Rev 1195) <br /> 206 £26'ON QNAA dANU31D 1SO ££:0Z L6/82/0T <br />