Box 059
L. 0....
~ See IfJSC1UCLiOll~;:b~iTc~i~}~~~~~;~LZ :(~:IJ~~~~~:r~~~~r~J;18lin9 chis form.
lb. TIEr ARTMTINT/UNIT
C-U""-t 1 fl. \ ll(
lEL GOVERNMENT/AGENCY
\' Q'V-:;'I/"\ '\) ~
2, RECORDS SERIES TITLE
\u\ 1 ).-
\lC\}-
Wk~ ~\'I\~ ((
\ {(
3. DATE SPAN
4, RECORDS SERIES DESCRIPTION (Dcscribe conLene imd CIJili'ilCLerisLics of records)
? L-')\ " \ \
\1&\L
5, ARRANGEMENT
o Alphabclical 0 Numencal
o Other (Specify):
6a. RETENTION
I '
o NO[ scheduled 0 Permanent 0 ApprilJSe for hiswfJcal villue
J4. Soh,d"led ;owm,"" S '5. \ 'l
6b SCHEDULE AND ITEM NUMBER, ORREAS j .FORPROPOSED RETENTION
.~ Chronological
o Alphilnumeric
~l
7, LOCATION ?
Ck-< 'Y'\ W "1 ~ ~
8. FORMAT
'A Paper 0 AudiOVisual 0 MicrographiC 0 EJecLroruc
g, TOTAL QUANTITY (In cubic feel ornumber of J18ms),
.){ Cubic feeL 0 Items:
10. ANNUAL ACCUMULATION (JD cubic feeL or number of ilems)
~cubicfeeL: o Items:
11 JlREQUENCY OF USE,
o Dady 0 Weekly 0 Momhly Seldom
11 RESTRICTIONS ON USE
~\l\
RECORDSARE
13. O]]\} POOR CONDITiON
14, 0 VITAL (EssenLialLO opera lions)
15. )i( OFFJClAL COPIES
16a. NAl F PERSON COMPLETING FORM
~, DWvv ~
~Q~J
Type of ilems:
o Never
16b DATE
L) ~ lJ.' () "
soxt
~()
enS.2 (12120021
91.700:15 92.IQ6 CDC