FORM REPLACES EDITION OF I JAN 67, WHICH 13 OBSOLETE. DDI APR 5,633-4 XEP0.T,WEj Appro)N4M". I %W~~t%~LCIA-RDP96-00792RO0011 (RESEARCH AND DEVELOPMENT) 1014QQZO;14,,~,,,d Budget Bureau No. 22-ROIOO This form is for use when (i) submission of cost or,ing ditta (see ASPR 3-807.3) is "'Ahorized by the contracting offic required and (ii) substitution for the DD Form 633 is er. PAGE NO. NO. OF PAGES 2 NAME OF OFFIROR SRI International SUPPLIES AND/OR SERVICES TO BE FURNISHED Research HOM E 0 F F1 C E ADDR ESS (Include ZIP Code) 333 Ravenswood Avenue Menlo Park, California 94025 DIVISION(S) AND LOCATION(S) WHERE WORK IS TO BE PERFORMED As above TOTAL AMOUNT OF PROPOSAL 1$ 74,986 I GOVT SOLICITATION NO. DETAIL DESCRIPTION OF COST ELEMENTS 1. DIRECT MATERIAL. (Itemize on Exhibit A) EST COST($) TOTAL EST COSTI REFER_ 2. ENCE a. PURCHASED PARTS b. SUBCONTRACTEDITEMS C. OTHER - (1) RAW MATERIAL (2) YOUR STANDARD COMMERCIAL ITEMS (3) INTERDIVISIONAL TRANSFERS (At other than cost) TOTAL DIRECT MATERIAL 2. MATERIAL OVERHEAD 3 (Rate 71X $base=) 3. DIRECT LA13OR (Specify) ESTIMATED HOURS RATE/ HOUR EST COST ($) ................ ............. ........... ............ .................... TOTAL DIRECT LABOR ............. ................. 4. LABOR OVERHEAD (Specify department or cost cehter)3 O.H. RATE X eASE EST COST ($) . . . . . . . . . . . . . ............. TOTAL LABOR OVERHEAD ... .................... . S. SPECIAL TESTING (Including field work at Government Installations) EST COST ($) ................ ................. TOTAL SPECIAL TESTING ............ 6. SPECIAL EQUIPMENT (It direct charge) (Itemize on Exhibit A) 7. TRAVEL (11 direct charge) (Give details on attached Schedule) EST COST ($) TRANSRORTATION .......... b. PER DIEM OR SUBSISTENCE ....... ...... TOTAL TRAVEL 8. CONSULTANTS (Identify - purpose rate) EST COST TOTAL CONSULTANTS 9. OTHER DIRECT COSTS (Itemize on Exhibit A) 10. TOTAL DIRECT-COST AND OVER11EAD 11. GENERAL AND ADMINISTRATIVE EXPENSE (Rate of cost element Non. 3 12. ROYALTIES 4 13. TOTAL ESTIMATED COST See Part Two- -Contrac tual 14. FEE OR PROFIT Provisions N@ . ESU 79 -100 15. TOTAL ESTIMATED COST AND FEE OR PROFIT This proposal is submitted for use in connection with and in response to (Describe RFP, etc. P and reflects our best estimates as of this date, in accordance with the itistructions to offerors and the footnotes which follow. TYPED NAME AND TITLE 111111P J. O'Donnell Manager Contrant AdwjnfttrG!tj0n L StGNATURt- NAMU OF FIRM SRI International. DATE OF SUBMISSION 1976 SEP 98- E ftWrT06edW"51V&sLC"Q9M11l&@ i QJAzJRn13I9&fln11A99fJJM too =078sts, COST EL NO, ITEM DESCRIPTION (See footnote 5) EST COST HAVE THE DEPARTMENT OF DEFENSE, NATIONAL AERONAUTICS AND SPACE ADMINISTRATION, OR THE ATOMIC ENERGY COM- MISSION PERFORMED ANY REVIEW OF YOUR ACCOUNTS OR RECORDS IN CONNECTION WITH ANY OTHER GOVERNMENT PRIME CONTRACT OR SUBCONTRACT WITHIN THE PAST TWELVE MONTHS? ,-A YES No It yes, identify below. L NAME AND ADDRESS OF REVIEWING OFFICE (Include ZIP Code) TELEPHONE NUMBER/ EXTENSION Defense Contract Audit Agency, SRI Resident 415 326-6200@ X2089 11 WILL YOU REQUIRE THE USE OF ANY GOVERNMENT PROPERTY IN THE PERFORMANCE OF THIS PROPOSED CONTRACT? [@ YES q] NO It yes, identify on a separate page. III DO YOU REQUIRE GOVERNMENT CONTRACT FINANCING TO PERFORM THIS PROPOSED CONTRACT? M YES LX] N 0 if y,s, id,.tify: [_7 ADVANCE PAYMENTS El PROGRESS PAYMENTS OR EJ GUARANTEED LOANS IV. 00 YOU NOW HOLD ANY CONTRACT (or, do you have any independently financed (IR & D) pmjects) FOR THE SAME OR SIMILAR WORK CALLED FOR BY THIS PROPOSED CONTRACT7 E-] Y E S NO if yes, identify V. DOES THIS COST SUMMARY CONFORM WITH THE COST PRINCIPLES SET FORTH IN ASPR, SECTION XV (See 3-807.2 (c) (2))? I-K Y ES NO it no, explain on a separate page. INSTRUCTIONS 'ro I. The purpose of this form is to provide a standard format by which the offeror submits to the Government a summary of in- curred and estimated cost (and attached supporting information) suitable for detailed review and analysis. Prior to the award of a contract resulting from this proposal the offeror shall, under the conditions stated in ASPR 3-807.3, be required to ,submit a Certificate of Current Cost or Pricing Data (see ASPR 3-807.3(e) and 3-807.4). 2. As part of the specific information required by this form, the offeror must submit with this form, and clearly identify as such, cost or pricing data (that is, data which is verifiable and fac- tual and otherwise as defined in ASPR 3-807.3(e)). In addition, he must submit with this form any information reasonably requir- ed to explain the offeror's estimating process, including: a. the judgmental factors applied and the mathematical or other methods used in the estimate including those used in projecting from known data, and b. the contingencies used by offeror in his proposed price. FOOTNOTES I Enter in this column those necessary and reasonable costs which in the judgment of the offeror will properly be incurred in the efficient performance of the contract. When any of the costs in this column have already been incurred (e.g., on a letter contract or change order), describe thein on an altahed supporting schedule. Identify all sales and transfers between your plants, divisions, or organizations under a common con- trol, which are included at other than the lower of cost to the original transferror or current market price. 2 When space in addition to that available in Exh.ibit A is required, attach separate pages as necessary and identify in this "Reference" column the attachment in which information supporting the specific cost element may be found. No stand- ard format is prescribed; however, the rost or pricing data must be accurate, completc and current, arid the judgment factors used in projecting from the data to the estimates must be stated in sufficient detail to enable the contracting officer to evaluate the proposal. For example, provide the basis used for pricing materials stich as by vendor quotations, shop estimates, or invoice prices; the reason for use of overhead rates which de- part significantlY from experienced rates (reduced volume, a planned major rearrantlemen f, etc.): or justification for an in- crease in labor rates\(anticipated wage and salary increases, etc.). Identify arid explain any contingencies which are included in the proposed price, such as anticipated costs of rejects and defective work, or anticipated technical difficulties. OFFERORS 3. When attachment of supporting cost or pricing data to this form is impracticable, the data will be specifically identified and described (with schedules as appropriate), and made available to the contracting officer or his representative upon request -1. The format for the "Cost Elements" is not intended as rigid requirements. These may be presented in different format with the prior approval of the contracting officer if required for more effective and efficient presentation. In all other respects this form will be completed and submitted without change. 5. By submission of this proposalofferor, if selected for negotiation, rrants to the contracting officer, or his author- ized representative, the right to examine, for the purpose of verifying the cost or pricing data submitted, those books, records, documents and other supporting data which will permit adequate evaluation of such Cost or pricing data, along with the computations and projections used therein. J'his right may be exercised in connection with any negotiations prior to contract award. .7 Indicate the rates used and provide an appropriate explana- h6n. Khere agreement has b--en reached with Government rep- reseniativcs on the use of forward pricing rates, describe the nature of the agreeinent. Provide the method of computation and application ol you, overhead expense, including cost breakdown and showing trends and budgetary data as neces- sary to provide a basis for evaluation of the reasonableness of proposed rates. 4 If the total royalty cost entered.here is in excess of $250 provide on a separate page (or on Db Form 783, Royalty Report) the. following information on each separate item of royalty or license tee: name and address of licensor; date of license agreement; patent numbeis, patent application serial numbers, or other basis on which the royalty is payable; brief description, including any part or model numbers of each con- tract item or component on which the royalty is payable; per- centage or dollar rate of royalty per unit; unit price of contract item; number of units; and total dollar amount of royalties. In addition, if specifically requested by the contracting office.r, a copy of the current license agreement and identification of applicable claims of specific patents shall be provided. 5 Provide a list of principal items within each category in- dicattrig known or anticipated source, quantity, unit price, competition obtained, and basis of establishing source arid reasonableness of cost. A,-: Approved FmxRWeaseF200&Qfii1O : CIA-RDP96-00792ROOO, CONTRACT PRICING PROPOSAL (RESEARCH AND DEVELOPMENT) 00140026-4 Form Approved Budget Bureau No. 22-ROZOO This form is for use when (i) submission of cost or pF .in data (see ASPR 3-807.3) is 84 g required and (ii) substitution for the DD Form 633 is thorized by the contracting officer. PAGE NO. NO. OF PAGES 2 NAME OF OFFEROR SRI International SUPPLIES AND/OR SERVICES TO BE FURNISHED Research HOME OFFICE ADDRESS (include ZIP Code) 333 Ravenswood Avenue Menlo Park, California 94025 DIVISION(S) AND LOCATION(S) WHERE WORK is TO BE PERFORMED As above TOTAL AMOUNT OF PROPOSAL $ 74,986 GOVT SOLICITATION NO. DETAIL DESCRIPTIO N OF COST ELEMENTS 1. DIRECT MATERIAL (Itemize on Exhibit A) EST COST TOTAL EST COSTI REFER- 2 ENCE a. PURCHASED PARTS b. SUBCONTRACTEDITEMS ............ C. OTHER -(1) RAW MATERIAL (2) YOUR STANDARD COMMERCIAL ITEMS ....... (3) INTERDIVISIONAL TRANSFERS (At other than coat) TOTAL DIRECT MATERIAL 2. MATERIAL OVERHE@AD 3 (Rate X $ base 3. DIRECT LABOR (Specify) ESTIMATED HOURS RATE/ HOUR EST COST ............ .................... ................... .................... .................. TOTAL DIRECT LABOR ................... .............. ......... ..... ....................... 4. LABOR OVERHEAD (Specify department or cost center)3 O.H. RATE X BASE EST COST .............. TOTAL LABOR OVERHEAD 5. SPECIAL TESTING (Including fieldwork at Government installations) EST COST ............ ................. .......... .............. TOTAL SPECIAL TESTING 6., SPECIAL EQUIPMENT (If direct charge) (Itemize on Exhibit A) 7. TRAVEL (11 direct charge) (Give details on attached Schedule) EST COST a. TRANSPORTATION .................... .................... b. PER DIEM OR SUBSISTENCE TOTAL TRAVEL . ....................... 8. CONSULTANTS (Identity -purpose -rate) EST COST .......... ................... .................... .................... ............ TOTAL CONSULTANTS 9. OTHER DIRECT COSTS (Itemize on Exhibit A) 10. TOTAL DIRECT COST AND OVERHEAD 11. GENERAL AND ADMINISTRATIVE EXPENSE (Rate 176 of cost element Nos. )3 12. ROYALTIES 4 13. TOTAL ESTIMATED COST See Part Two- -Contrac tual 14. FEE OR PROFIT Provisions N4 . ESU 71 -100 15. TOTAL ESTIMATED COST AND FEE OR PROFIT This proposal is submitted for use in connection with and in response to (Describe RFP, etc. t and reflects our best estimates as of this date, in accordance with the instructions to offerors and the footnotes which follow. TYPED NAME AND TITLE Philip J. O'Donnell: Manager 1'ojotrant Admill SIGNATU" NAME OF FIRM SRI International ATE OF SUBMISSION 16@ 78 SEP 9-9- REPLACES E.ITION OF t IAN .1. WHICH IS OBSOLETE. L) L) t)L'$'AFpr&ed For Release 2003/09/1 0: CIA-RDP96-00792ROO0100140026-4 E COST EL NO. I ITEM DESCRIPTION (See footnote 5) EST COST I. HAVE THE DEPARTMENT OF DEFENSE, NATIONAL AERONAUTICS AND SPACE ADMINISTRATION, OR THE ATOMIC ENERGY COM- MISSION PERFORMED ANY REVIEW OF YOUR ACCOUNTS OR RECORDS IN CONNECTION WITH ANY OTHER GOVERNMENT PRIME CONTRACT OR SUBCONTRACT WITHIN THE PAST TWELVE MONTHS? [:M YES E] N 0 If yes, iden illy below. NAME AND ADDRESS OF REVIEWING OFFICE (Include ZIP Code) TELEPHONE NUMBER/ EXTENSION Defense Contract Audit Apency. SRI Resident 415 326-6200. X2089 11 WILL YOU REQUIRE THE USE OF ANY GOVERNMENT PROPERTY IN THE PERFORMANCE OF THIS PROPOSED CONTRACTT [@] Y E S P@] NO It yes, identify on a separate page. 111. DO YOU REQUIRE GOVERNMENT CONTRACT FINANCING TO PERFORM THIS PROPOSED CONTRACT? F [M NO it yes, identify.-, L-] ADVANCE PAYMENTS E] PROGRESS PAYMENTS OR D GUARANTEED LOANS ,@] YES IV DO YOU NOW HOLD ANY CONTRACT (or, do you have any independently financed(IR& D) projects) FOR THE SAME OR SIMILAR WORK CALLED FOR BY THIS PROPOSED CONTRACT7 E:1 YES [r] NO If yes, identify V. DOES THIS COST SUMMARY CONFORM WITH THE COST PRINCIPLES SET FORTH IN ASPR, SECTION XV (See 3-807.2 (c) (2))? Y ES NO It no, explain on a separate page. INSTRUCTIONS 'ro 1. The purpose of this form is to provide a standard format by which the offeror submits to the Government a summary of in- curred and estimated cost (and attached supporting information) suitable for detailed review and analysis. Prior to the award of a contract resulting from this proposal the offeror shall, under the conditions stated in ASPR 3-807.3, be required to submit a Certificate of Current Cost or Pricing Data (see ASPR 3-807.3(e) and 3-807.4). 2. As part of the specific information required by this form, the offeror must submit with this form, and clearly identify as such, cost or pricing data (that is, data which is verifiable and fac- tual and otherwise as defined in ASPR 3-807.3(e)). In addition, he must submit with this form any information reasonably requir- ed to explain the offeror's estimating process, including- a. the judgmental factors applied and the mathematical or other methods used in the estimate including those used in projecting from known data, and J. the contingencies used by offeror in his proposed price. OFFERORS 3. When attachment of supporting cost or pricing data to this form is impracticable, the data will be specifically identified and described (with @;chedules as appropriate), and made available to the contracting officer or his representative upon request. 4. The format for the "Cost Flements" is not intended as rigid requirements. These may be presented in different format with the prior approval of the contracting officer if required for more effective and efficient presentation. In all other respects this form will be completed and submitted without change. 5. By submission of this proposalofferor, if selected for negotiation, grants to the contracting officer, or his author- ized representative, the right to examine, for the purpose of verifying the cost or pricing data submitted, those books, records, documents and other supporting data which will permit ad.equate evaluation of such cost or pricing data, along with the computations and projections used therein. This right may be exercised in connection with any negotiations prior to contract award, FOOTNOTES I Enter in this column those necessary and reasonable costs which in the judgment of the offeror will properly be incurred in the efficient performance of the contract. When any of the costs in this column have already been incurred (e.g., on a letter contract or change order), describe them on an attached supporting schedule. Identify all sales and transfers between your plants, divisions, or organizations under a common con- trol, which are included at other than the lower of cost to the original transferror or current market price. 2 When space in 'addition to that available in Exhibit A is required, attach separate pages as necessary and identify in this "Reference" column the attachment in which information supporting the specific cost element may be found. No stand- ard format is prescribed; however, the cost or pricing data must be accurate, complete and current, and the judgment factors used in projecting from the data to the estimates must be staied in sufficient detail to enable the contracting officer to evaluate the proposal. For example, provide the basis used for pricing materials such as by vendor quotations, shop estimates, or invoice prices; the reason for use of overhead rates which de- part significantlY from experienced rates (reduced volume, a planned major rearran6ement, etc.): or justification for an in- crease in labor rates anticipated @'C wage and salary increases, etc.). Identify and explain any contingencies which are included in the proposed price, such as anticipated costs of rejects and defective work, or anticipated technical difficulties. 3 Indicate the rates used and provide an appropriate explana- ii6n. Where agreement has baen reached with Government rep- resentatives on the use of forward pricing rates, describe the nature of the agreement. Provide the method of computation and application of your overhead expense, including cost breakdown and showing trends and budgetary data as neces- sary to provide a basis for evalua.tion of the reasonableness Of proposed fates. 4 If the total royalty cost entered here is in excess of $250 provide on a separate page (or on Db Form 783, Royalty Report) the following information on each separate item of royalty or license fee: name and address of licensor; date of license agreement, patent numbeis, patent application serial numbers, or other basis on which the royalty is payable; brief description, including any part or model numbers of each con- tract item or component on which the royalty is payable; per- centage or dollar rate of royalty per unit; unit price of contract itern; number of units; and total dollar amount of royalties. In addition, if specifically requested by the contracting officer, a copy of the current license agreement and identification of applicable claims of specific patents shall be provided. 5 Provide a list of principal items within each category in- dicattng known or anticipated source, quantity, unit price, competition obtained, and basis of establishing source and reasonableness of cost. E XAPOTo4veduIP615 E-MDESC-RIPT-ION (" EST COST Soo footnote 5) [COST EL NO IT 1. HAVE THE DEPARTMENT OF DEFENSE. NATIONAL AERONAUTICS AND SPACE ADMINISTRATION, OR THE ATOMIC ENERGY COM- MISSION PERFORMED ANY REVIEW OF YOUR ACCOUNTS OR RECORDS IN CONNECTION WITH ANY OTHER GOVERNMENT PRIME CONTRACT OR SUBCONTRACT WITHIN THE PAST TWELVE MONTHS? LJ YES D NO It yes, identify below. NAME AND AODRESS OF REVIEWING OFFICE (Include ZIP Code) TELEPHONE NUMBER/ EXTENSION Defense Contract Audit Agency, SRI Resident 415 326-6200P X2089 I). WILL YOU REQUIRE THE USE OF ANY GOVERNMENT PROPERTY IN THE PERFORMANCE OF THIS PROPOSED CONTRACT? YES @Xl NO It yes, identify on a separate page. 111. 00 YOU REQUIRE GOVERNMENT CONTRACT FINANCING TO PERFORM THIS PROPOSED CONTRACT? YES JQ NO itye.,, idenfify@ [::-] ADVANCEPAYMENTS El PROGRE5SPAYMENTSOR GUARANTEED LOANS IV. DO YOU NOW HOLD ANY CONTRACT (or, do you have any independently financed (IR & D) projects) FOR THE SAME OR SIMILAR WORK CALLED FOR BY THIS PROPOSED CONTRACT? F-] YES X1 NO Ityes, identify V. DOES THIS COST SUMMARY CONFORM WITH THE COST PRINCIPLES SET FORTH IN ASPR, SECTION XV (See 3-807.2 (c) (2))? i-N YES NO it no, explain on a separate page. INSTRUCTIONS 'ro 1. The purpose of this form is to provide a standard format by which the offeror submits to the Government a summary of in- curred and estimated cost (and attached supporting information) suitable for detailed review and analysis. Prior to the award of a contract resulting from this proposal the offeror shall, under the conditions stated in ASPR 3-807.3, be required to submit a Certificate of Current Cost or Pricing Data (see ASPR 3-807.3(e) and 3-807,4). 2. As part of the specific information required by this form, the offeror must submit with this form, and clearly identify as such, cost or pricing data (that is, data which is verifiable and fac- tual and otherwise as defined in ASPR 3-807.3(e)). In addition, he must submit with this form any information reasonably requir- ed to explain the offeror's estimating process, including: a. the judgmental factors applied and the mathematical or other methods used in the estimate including those used in projecting from known data, and b. the contingencies used by offeror in his proposed price. OFFERORS 3. When attachment of supporting cost or pricing data to this form is impracticable, the data will be specifically identified and described (with chodules as appropriate), and made available to the contracting officer or his representative upon request. -4. The format for the "Cost Elements" is not intended as 61'Lcl requirements. I'hese may be presented in different foirnat with the prior approval of the contracting officer if required for more effective and efficient presentation. In all other reqp(!cts this form will be completed and submitted without change. 5. Py submission of this proposal, offeror, if selected fnr negotiation, Vrants to the contracting officer, or his author- ized representative, the right to examine, for the purpose of verifying the cost or pricing data submitted, those books, records, documents and other supporting data which will permit adequate evaluation of such cost or pricing data, along with. the computations and projections used therein. This right may be exercised in connection with any negotiations prior to contract award. FOOTNOTES I Fritter in this column those necessary and reasonable costs which in the judgment of the offeror will properly be incurred in the efficient performance of the contract. When any of the costs in this column have already been incurred (e.g., on a letter contract or changle order), describe then? on an attached supporting schedule. Identify all sales and transfers between your plants, divisions, or organizations tinder a common cort.- trol, which are include(] at other than the lower of cost to the original transterror or current market price. 2 lfhen space in addition to that available in Exhibit A is required, attach separate pages as necessary and identify in this "Reference" column the attachment in which information supporting the specifit. cost element may be found. No stand- ard format is prescribed; however, the. cost or pricing data must be accurate, complete and current, and the judgment factors used in projecting frorn the data to the estimates must be stated in sufficient detail to enable the contracting officer to evaluate the Proposal. For example, provide the basis used for pricing materials such as by, vendor quotations, shop estimates, or invoice prices; the reason for use of overhead rates vthich de- part significantli, front experienced rates (reduced volume, a planned major rv@irran_@errient etc.): orjustification for an in- crease in labor rittes"(anticipated wage and salary increases, etc.). Identify and explain airy conlinilencies which are Included in the propos(,d price, nuch as anticipated costs of rejects arid defe( five work, or anticipated technical difficulties. 3 Indic ate the rates used and provide an appropriate eKplana- h6n. Where cipreement has b,3en reached with Government rep- resentatives on the use of forward pricing rates, describe the nature of the agreement. Provide the method of computation and application of your overhead expense, including cost breakdown arid showing trends and budgetary data as noces- sary to provide a basis for evaluation of the reasonableness of proposed rates. 4 If the total royalty cost entered,here is in excess of $250 provide on a separate page (or on DD Form 783, Royalty Report) the following information on each separate item of royalty or license fee: name arid address of licensor; date of license agreement; patent numbeis, patent application serial numbers, or other basis on which the royalty is payable; brief descrip tion, including any part or model numbers of each con- tract item or component on which the royalty is payable; Per- centage or dollar rate of royalty per unit; unit Price of contract Item; number of units; and total dollar amount of royalties. In addition, it specifically retluesfed by the contracting oificep a copy of the current license agreement and identification of applicable claims of specific patents shall be provided. 5 Provide a list of principal items within each category in- dicatthIl known or anticipated sourco, quantity, tinit price, competition obtained, arid basis of establishing source an d reasonableness of cost. % P, U.S GOVERNMENT PRINTING OFFICE: 1974 - 558 - 057 -1 NMOWNPM W Muuw 1 ww 2 Oct 78 F.T@u-44 h 1 380-5; the proponent agency is the Office, Assistant Chief of Staff for Infellige SECTION A - GENERAL 70: MAJ STONER, DAMI-ISH FROM: hand carried DATE RECEIVED ACTION OFFICE(S) I SUSPENSE DATE(S) i REGISTER OR CONTROL NO. CONTROL, LOG OR FILE NO. CLASSIFI- CATION NUMBEROF COPIES DESCRIPTION (Type. File Ref, Unclassilipci Subject or Short Title and Number of IndoisementslInels) DATE OF DOCUMENT ORIGINATOR S 1 letter, w/SRI Proposal No. ESU 78-100 (3 cys) DID Form 633-4 (3 cys) ------------- NOTHING FOLLOWS ----------- 28Sep78 SRI SECTION B - ROUTING TO COPY NO. DATE PRINTED NAME SIGNATURE 2. 3. 4. SECTION C - DESTRUCTION CERTIFICATE (Check appropriale block) MATERIAL DESCRIBED HEREON HAS BEEN: El DESTROYED D TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR380-5) OFFICESYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE DESTRUCTION RECORD NO. DATE PRINTED NAME OF CERTIFYING/DESTR. OFF. SIGNATURE PAGE OR COPY NUMBER DATE PRINTED NAME OF WITNESSING OFFICIAL SIGNATURE -SECTION D - REPRODUCTION AUTHORITY NUMBER OF COPIES TO BE REPROD CED AUTHORIZED BY DATE SECTION E - RECEIPT/TRACER ACTION (Chech appropriate blocle) RECEIPT OF DOCUMENT(S) ACKNOWLEDGED D DOCUMENT@S) HAVE NOT BEEN RECEIVED TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED, DATE PRINTED NAME, GRADE OR TITLE SIGNATURE -- 4 i4e COMMENTS U[U/-KU U11 Approved For Release 2003109110 CIA-RDP96-0 U%J -1 Lim r%j,Km a7Q-1., 1 1-40v 1,L - @@KM@ 14U@, t @@F @@! I ZV4. I JAN @Q: 06 1, 1 - @4 ANU 546, 1 OCT 63. WHICH ARE OBSOLETE.