AppYdVWPtfMtOiLiNW2MMBMT!"C[A-IRBPWG-00788 ROO fSU0210003-0 Fad, use of this f*Vm, see At 380-3. the proponent agency is the Office, Assislano Chief. *I Staff $or IntalliSonc SECTION A - GENERAL TO: DATE PECEIVED ACTION OFFICE(S) SUSPENSE DATE(S) REGISTER OR CONTROL NQ, CONTROL. LOG CLASSWIr NUMBER OF DESCRIPTION (T_ype*File Ref- (hiclessifiedSubject DATE OF OR FILE NO. CATION COF4ES or Short Tale and Number of IndorsementsIly2cls) DOCUMENT ORIGINATOR CL-008-83 S/NOFORJ 1 Cy I of 1, Report CL-986/B21I./07 ...... .. .................................... NOTHING FOLLOWS ............... ....... ........... TO 4. SECTION 9 - ROUTING COPY NO,_~~ DATE r-PRINTET) ZME SECTION C - DESTRUCTION CERTIFICATE ~ Check upp,.priwe block) MATERIAL DESCRIBED HEREON HAS BEEN PAGE OR COPY El IDE$TROYED 0 TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR380-5) '56- --- I - ~ - - - - - - - -- --- -- - -6FiiZE iYM L IAN OR REP Ofil RUC OF CERfIFYING/DESTR. OF~ GNATLIRE PAGIF OR COPY NUMEIE~R 1-iT RINTED NAME OF WITNESSING OFFICIA SIGNATURE SECTION 0 - REPRODUCTION AUTHORITY NVMBER OF COPIES To BE REPRODUCE D I)ATE SZ-TION E - RICEIPT/TRACER ACTION eChek upprolmate block,, [3RECEIPI ~X DOCUMENTIS) ACKNOWLEDGED HAVE. NOT BEEN RECEIVED F-ITRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE. HAS NOT BEEN RECEIVED. RT DATE ED NAME, GRADE OR TITLE SIGNATURE J;TT D A FORM 3M, I Wig EDITION OF I NOV 72 IS OBSOLETE. C! A k1bi-P.- 9-66-0 189 8" A- 7- s4v