Laserfiche WebLink
PUBLIC RECORD RELEASE REQUEST <br />1. REQUEST RELEASE DATE \7-i4 1,:X 0,(, I /98:!� <br />REQUESTING AGENCY %h,5- /6//t -/e 64ssoCjN-1F5 <br />PHONE N0./4/S-).663-`J/00 <br />3. AGENCY ADDRESS -2-60 e CfTL/P�o2Aj/ <br />/A 5,rggw'T <br />�>�'AI FN-A1v'C�SCO. <br />CifGIFD/zitJ'i{�- <br />99)l � - <br />4. INDIVIDUAL REQUESTING WEA/Er C°•T <br />C,IjeTs2 <br />PHONE NO.��lS�563-`)/OCA <br />5. INDIVIDUAL ADDRESS ,24og 0-#[jFop-Aj1)3 <br />FILE ADDRESS ITEM REQUESTED <br />DATE <br />PURPOSE OF REQUEST <br />/10 0�1 it) Redondo )x-74 w Foa <br />Gtk f l <br />7 -ti --78 <br />Co,�si+eue M 6 e <br />cCrn p <br />.:rA vej k 1 iov� <br />*ASTERISK ITEMS <br />REQUESTED FOR PHOTOCOPYING <br />7246 <br />SIGNATURE OF REQUESTING PARTY %ho <br />C 7 <br />DATE <br />LOCAL HEALTH DISTRICT USE ONLY <br />PROJECTED RELEASE DATE <br />n <br />SIGNATURE OF RELEASING OFFICIAL <br />o <br />DATE7/-,' 6 le <br />NAMES OF STAFF MEMBERS INVOLVED IN THE RELEASE <br />AD <br />MONITORING OF THE RECORDS. <br />EH 00 14 4/81 <br />