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PUBLIC RECORD RELEASE REQUEST <br /> 1 . REQUEST RELEASE <br /> 2. REQUESTING AGENCY PHONE NO. <br /> 3. AGENCY ADDRESS k(a k) r£C ],1&z- <br /> q aq5 'bu S I N c"ss \\ <br /> 4. INDIVIDUAL REQUESTING S�FUi✓ rJku6-ug.T PHONE NO.(qlCpJ3(0l0l---�o1 <br /> 5. INDIVIDUAL ADDRESS <br /> FILE ADDRESS ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> Z151 lbuorgf-? G_„e, fifn ,b IuSe1 4-3-85 0�A&nn.o) 2t)-z, C. , <br /> L <br /> 2cr l cluoTm Q b LbTaL--rt, �nv r C` boo,g- 2r,--B <br /> *ASTERISK ITEMS REQUESTED FOR PHOTOCOPYING <br /> SIGNATURE OF REQUESTING PARTY DATE <br /> LOCAL HEALTH DISTRICT 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 RECORDS. <br /> 07 <br /> CULF <br /> EH 00 14 4/81 <br />