Laserfiche WebLink
40 4 <br /> PUBLIC HEALTH OEEVICEU <br /> PUBLIC RECORD hELLASL REQUHST <br /> I. itEoolt9l+ tlELEASE bATE _ - 101 Fayg1 <br /> 21 ttEQU99Tt d AdENCY ��rz�,A�® :9 PtiONE No- <br /> :31, AdLNCY AtibAM19 , �3 <br /> 4 , INDIVIBU L REQUESTING �R,e D, � Tnbu Pf{ONE NO. <br /> 5, tNbfVfbOAL AbbttESs <br /> A J <br /> I <br /> V-1L8 ADDRESS ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> 4 ASTitntak f SMS ttEQUESTEb POR P110T000 YING <br /> $SIGNATURE OV 2t19Qt1LSttN0, PAPTY ;5% DATE r-i fas � <br /> PUBLIC HEALTH SEttVICES USE ONLY <br /> PROJECTEb RELEASE bATE <br /> SIGNATURE or htb9ASING OPPICIAL DATE <br /> NAMES Off' STAPP MEMSERS INVOLVED IN THE RELEASE AND MONITORING <br /> Off' THE RECORbs a <br /> Ell M4 Up <br /> . t • <br />