ient/Guanfan dame aelaoonsivip to Mort -11_40,e Date bin ass want rammer to recant iltUrsitrotthe haste Surbfrt to roes, Ouse prose ewth vow: (Please Pont) Noway Email / Call Consent ts nowt and hum •00sot saint; MAW Sugary and The imoode of Into Meats noi..fro ass Fenner n carnal ta tartar IkNI N

my behalf before the Commission. 3. a a-t5 Date Signature (fLeondau/Agent) Title RESPONDENT: a —Cc /N C-re < ;1/49-1 tiTh Mailing Address: (Please Pont) Telephone (H): (Committee Na Co k Or) CAL e/ Compiny Name/Individual Named in Notification Letter) if P r; SA' • Al AC3 ten 45 U Sv k C0k