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. � . <br />PUBLIC RECORD RELEASE REQUEST <br />1. REQUEST RELEASE DATE_ 9-/z0/A9 _ <br />2. REQUESTING AGENCY [. Lcyw E F7A,cK r PHONE N0. C41r� 6sz aroma <br />3. AGENCY ADDRESS / 900 Pou 4 L� Srac ,F T <br />67M da 'i %/. Lc e' _ CA 94608 <br />4. INDIVIDUAL REQUESTING 4,j L . JRIGHT PHONE NO. <br />5, INDIVIDUAL ADDRESS <br />FILE ADDRESS ITEM REQUESTED DATE <br />282r W. a.s6; ��.r agt,-i � <br />2 441 rju y <br />3003 rJ dv fin'✓� <br />3015' nl.u/y �rwt <br />20+1 N-7 b rye e <br />PURPOSErrOF RI-EQUEST <br />�nvirun.n Qn'h.1 )i F<Afs.Crn /�� q�' <br />*ASTERISK ITEMS REQUES ED FOR PHOTOCOPYING <br />SIGNATURE OF REQUESTING PARTY '� JfJ DATE <br />LOCAL HEALTH DISTRICT USE ONLY <br />PROJECTED RELEASE DATE S- S <br />SIGNATURE OF RELEASING OFFICIA DATE Zf�f <br />NAMES OF STAFF MEMBERS INVOLV IN THE RELEASE AND MONITORING OF THE RECORDS. <br />— ()0r1/Ic�_ H1 CY-ccs <br />EH 00 14 <br />A 101 <br />