CIA STARGATE release
CIA-RDP96-00788R001200230025-8
Opens with: For use of this form, seo AR 380-5; the proponent agency Is the Office,
Warning: text for all documents has not been verified. Errors are possible. Check the original by document ID on CREST.
1 page, machine transcribed from the CIA’s released scan.
* U. S. GOVERNMENT PRINTING OFFICE: 1974-581-295 For use of this form, seo AR 380-5; the proponent agency Is the Office, Assistant Chief of Staff for Intelligence. 21 Jan 1980 SECTION A - GENERAL TO: FROM: DATE RECEIVED ACTION OFFICE(S) SUSPENSE DATE(S) - REGISTER OR CONTROL NO. CONTROL, LOG OR FILE NO. CLASSIFI- CATION NUMBER OF COPIES DESCRIPTION (Type, File Ref., Unclassified Subject or Short Title and Number of Indorsements/Incls) DATE OF DOCUMENT ORIGINATOR DAMA-ZD 1-80 S 1 Report by The GRILL FLAME Scientific Evaluation Committee (U) , Copy 1 of 35. Sealed Envelope Dec79 DAMA-ZD SECTION B - ROUTING COPY NO. DATE PRINTED NAME SIGNATURE 1. AS A(RDA) Dr. Yore T of 251 arjanso BE CALLAHAN Callahan 3. 4. MATERIAL DESCRIBED HEREON HAS BEEN: DESTROYED TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5) OFFICE SYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP. | SIGNATURE DESTRUCTION RECORD NO. DATE PRINTED NAME OF CERTIFYING/DESTR. OFF. SIGNATURE PAGE OR COPY NUMBER DATE PRINTED NAME OF WITNESSING OFFICIAL SIGNATURE SECTION D - REPRODUCTION AUTHORITY NUMBER OF COPIES TO BE REPRODUCED AUTHORIZED BY DATE SECTION E - RECEIPT/TRACER ACTION (Check appropriate block) RECEIPT OF DOCUMENT(S) ACKNOWLEDGED DOCUMENT(S) HAVE NOT BEEN RECEIVED TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED. DATE PRINTED NAME, GRADE OR TITLE SIGNATURE COMMENTS DA FORM 3964, 1 Nov 72 REPLACES DA FORMS 1203, 1 SEP 58: 1204, 1 JAN 60: 631, 1 MAR 62 AND 546, 1 OCT 63, WHICH ARE OBSOLETE. Approved For Release 2003/09/10 : CIA-RDP96-00788R001200230025-8 1. 2. SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)