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i <br /> PUBLIC RECORr RE LASE REQUEST <br /> THI'S REQUEST WILL BE HONOREDWHENITEMS 1-14 ARE TYPED, OR PRINTED CLEARLY IN INK <br /> 1 . REQUEST DATE q `7 2. REQUEST TIME I <br /> 3. RELEASE IS REQUESTED FOR WHAT DATE? Z fI .Z / 4. TIME <br /> 5. REQUESTING AGENCY Z/,fc�LC l I IZGf°Ex—1 e7--s <br /> 6. AGENCY ADDRESS ,zY TE <br /> -- 140-D5 -,� �_h� ►r- � 535d <br /> 7. INDIVIDUAL REQUESTING <br /> 8. INDIVIDUAL ADDRESS -1)2 , MQ C�r��i <br /> 9. TELEPHONE NO. SZI-&,o2,o <br /> 0. TITLE OF REQUESTED FILE -eelL �( <br /> 1 . ADDRESS OF REQUESTED FILE <br /> 2. ITEMS REQUESTED 5A-\J ,--A--rindJ 2efie ,4 i r _ z I S In/ 13. ITEM DATE - 5 - ;7-.6_7 <br /> 78 - 79/ /0-/9 - 70 <br /> - - - 20829 7� Iz - C� G <br /> 73 =33 73 <br /> Co / lP Z. -/C) <br /> _ S7s 2 - 2-1- 7( <br /> --- - - i3 93I _ 3 _ 1- & z <br /> F - <br /> *STAR ITEMS REQUESTED FOR PHOTOCOPYING <br /> 4. SIGNATURE OF REQUESTING PARTY _ DATE <br /> FOCAL HEALTH DISTRICT USE ONLY <br />'ROJECTED RELEASE DATE / loe4el� TIME <br /> SIGNATURE OF RELEASING OFFICIAL DATE Z <br /> VAME OF STAFF MEMBERS INVOLVED IN THE RELEASE OF RECORDS <br /> i. oI AJ <br /> v. <br />