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   Remote Viewer     :           
                                 

                                 
                                 

   Interviewer       :           
                                 

                                 
                                 

   Observer(s)       :           
                                 

                                 
                                 

                                 
                                 

                                 
                                 

   Date              :           
                                 

                                 
                                 

   starting time     : hour      s, local
                                 

                                 
                                 

   Site                          
                                 

                                 
                                 

   Site Acquisit     .:(-& ERV   PRV ARV BRV Other
                     Y)          
                                 

                                 
                                 

   working Mode      GT HEM      Other
                                 

                                 
                                 

   Feedback clas     s: B        C
                                 

                                 
                                 

                                 
                                 

   Ending time )JO hours, local
   Notes
   Highest stage
   Evaluation
   AV -AMR,
   Actual site wvv~ 6 Tg-" e. s,
   RV summary
   Approved For Release 2000/08/08 CIA-RDP96-00789ROO1700470029-2

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