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Dae Reced INFORMATION RELEASE REQUEST Wef-re-ce4<br />
Complete for all Types of Release<br />
El Speech or<br />
Presentation<br />
Purpose<br />
(Check 43<br />
Rp eference<br />
jrechnlcal Report<br />
ID Number (include revision, volume, etc.)<br />
WHC-SD-EN-TI-136, Rev. 0<br />
C3 FuLl Paper only 0 E Thesis or List attachmments.<br />
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0<br />
Summary<br />
Abstract<br />
suffix) Dissertation<br />
a ManuamEDl363<br />
a] Brochure/FLier ET163<br />
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Speakers Bureau<br />
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Software/Database<br />
Control led Document<br />
Other<br />
DaaRlseeqid<br />
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Jn ,19<br />
11 Videotaoe _____________ _______________________<br />
Tit nde e 1 0 g -r TitelO..NAra<br />
A und r a Sto ag Ta k l os re Unclassified Category7I p c<br />
ndrgoud SorgeTak lours tC- 630 ILevel 4<br />
New or novel (patentable) subject matter? [ NO [H Information received from others in confidence, such as<br />
Yes proprietary data, trade secrets, and/or inventions?<br />
If NYesH, has disclosure been submitted by WNC or other No [7] Yes (identify)<br />
company?<br />
[1No [HYes__DisclosureNo(s). ___________________________<br />
Copyrights? [A No 1]Yes Trademarks?<br />
If NYes", has written permission been granted? No [] Yes (identify)<br />
[]No [] Yes (Attach Permission)<br />
Complete for Speech or Presentation<br />
Title of Conference or Meeting Group or Society Sponsoring<br />
Date(s) of Conference or Meeting City/Stsa Witt proceedings be [] Yes [J No<br />
published? YsN<br />
Witt material be handed [ e ] N<br />
out?<br />
Title of Journal<br />
CHECKLIST FOR SIGNATORIES<br />
Review Reaiui red per WHC-CM-3-4 Yes No Reviewer - Signature Indicates Approval<br />
Classification/Unclassified<br />
Controlled Nuclear Information<br />
Patent - General Counsel<br />
Legal -General Counsel<br />
[<br />
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1<br />
[H<br />
[1<br />
!Nme(prnted)<br />
_______________________________<br />
S. W. Berglin<br />
S. W. Berglin<br />
'<br />
Sionature Date<br />
Y 3<br />
Applied Technology/Export<br />
Controlled Information or<br />
International Program_________________________________<br />
WHC Program/Project<br />
Commuications<br />
RL Program/Project<br />
Publication Services<br />
Other Program/Project<br />
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0]. Vatson<br />
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M. R. Knightf-<br />
Information conforms to all applicable requirements. The above information is certified to be correct.<br />
References Available to intended<br />
Audience<br />
Transmit to DOE-NO/Office of<br />
Yes No<br />
[]<br />
INFOR1MATION RELEASE ADMINISTRATION APPROVAL STAMP<br />
Stemp is required before release. Release is contingent upon<br />
resolution of mandatory comments.<br />
Scientific and Technical<br />
Information5d<br />
Author/Requestor (Print /Signatur<br />
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Date<br />
F0,<br />
Co A. Rnwlpy ;7<br />
Intende Audience VA<br />
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Responsible Manager (Printec/Signature).5/27/te<br />
R. C.Ros<br />
BD-7600-062 (04a"-V6074 Part 1
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