Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Box 35
C) I~t~C:;[)TdE, blVeIJWT\ DatE:! \NorJ:slJ8Bt ~5 :,1'1 IIJ:,IIlICIIOIl, 11, hJIJI,LclUO,' /'7[, J;JIll 'IJ/U/.I dlU/ I 'J,I/J/JI/li/, IlL'lOll LllliJI'!I'iiiJ!/IIJl. Ill!i! J I~ C~~::~~"(;~:r-- €;~t,jlf:~ITI'"<"T'~jiH 255 €S S;~_~! I ~~ r;Ec;oJW:~ SEJUU:"ITILL ulfl-v e Lf--. 11___5 'Iv' P;~_.___4_~~~ ~.ss rVLGrV+ )Co I ( :l. TJ/',11'; []I' Mi I~ ''''COl: uC"ilillicJciXk~, ,,,,;,il" co< CC,"," '" ,,' '" """"'"",,,,. "I '''''''',< I 'hiV 4l 1+<;,. C;~ 5> S f)~ b u {J L- ( C tt-rF<:--- /20 /1 5, ARRh_NGElvJENT o AJphaueucai [) Nurnencai ~~giCa' o iJphanurneric o Dtber (Specify) 5a. RETENTJON o '\Jm scheduled 0 FermaneDl ~uled rec~mlon o Appralse for hJSLOrical value r () yrs 61;" SCHEDtIl:E1'iNDTrEM -NUMBEP-.;' QR:RE}~SON PORPROFOSED.P ..ETENTlON d.. [SOJY .~ I~ 7, LOe/mON g, PORM}~n w4TH ~p8J 0 )\udlDvi,;ual 0 Micrographic :1. TOTJu.. QU/'J\1'Jm' (In CUUIC j eel OJ' number of Icems), ~JlC feeL L ( 0 hems: 1 l'J'-JNUh.l. ACCUlvfUU\Tl0N (In cubiC leel OJ' number of moms), ~JC f88L L ( Olwms JTFEQLIENCY QP USE, o Dai)y 0 Weekly 2. RESTRICTJONS ON U o ElecLJ(Jl1Jc o Seldom o Jvw nth)y ECORJJ5 h.J{E :J D\ PD:]}: CONDfTJDN i. [I \yt-:.l CSs~;efll;all(1 op::rauofls) j uvD?FJClJJ..., COPES )G Nf,j11E oJ' P::c.P.50NU~D 'SI1NG FCJJUYl ' ~C ~-- I' , / I / I /1 ------ ( z. . _ - -tll /.j !J~ ---) pt(Ln~ As: fif f(-SS-e5> ~'--- Type: of Ilmns: ~ .... 160 DI,Ti'C . qbq/o I ( I , I I , J C;}-'~S ~ rJ2':!CJCi2) (,' ?(,n'F, C')_I[". r.n: -4> f " '. " .. '" ...