Authorizer's Nat= & Ex' Stamp Authon 7Vd, k,g„atoe Client/Caller Name: refrelitx P LI Irri Client Telephone:I-916- t..o? - Li %I Li — 1004E) Call Back Narne. M..- Tell'i\n-4.A..)11 nj I Call Back Signature: AL/ f.- 4.,V, LJ Call Back Date/Time I° 14 In q.liOrtrif' CMS/Uiobal Hold Approval Obtained