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Badge #: tigg Ag "
INMATE GRIEVANCE APPEAL D&1'l'.€2:- E; K. I Q [Z:
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I am appealing the decision of I ag A rum.) ‘ for the reasons:
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Staff Signature Badge # Date
INQIE: You may appeal this decision, if appropriate, to the next: level, within 10 calendar
days.
INITIAL DISTRIBUTION: White & Yellow Grievance Coordinator Pink - Inmate
FINAL DIS'I'RIBU'I'I@~1: White — Inmate Yellow — Grievance File
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Case 2:03-cv-02159-ROS-JRI
Document 64-3
Filed 03/12/2007
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