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PLIC RECORD RELEASE RENE# <br /> I . REQUEST RELEASE DATE /7 J4LY83- <br /> REQUESTING AGENCY_hlooDWgkD- &VVK 6 WSo t7,-t Tf PHONE NO.( ITS-3000 <br /> 3. AGENCY ADDRESS loo RR- wcGE Ve J'u17,v3o0 <br /> WA�Nt�T CRiC-C-C, CA WrZ716 <br /> 4. INDIVIDUAL REQUESTING/i I�/yew Z;,��� i �,�3 PHONE NO.41S- -i 51344 l <br /> 5. INDIVIDUAL ADDRESS 0011e Avg Sf cin <br /> FILE ADDRESS ITEM REQUESTED DATE PURPOSE OF REQUEST <br /> *ASTERISK ITEMS REQUESTED POR PHOTOCOPYING <br /> SIGNATURE OF REQUESTING PARTx,,4i6kcuc fi ' DATE <br /> LOCAL HEALTH DISTRICT USE ONLY <br /> PROJECTED RELEASE DATE - -7_ <br /> SIGNATURE OF RELEASING OFFICIAL DATE__/ =k� <br /> NAMES OF STAFF MEMBERS INYO D IN THE RELEASE AND MONITORING OF THE RECORDS. <br /> EH 00 14 4/81 <br />