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THE ITEMS LISTED BELOW WERE LOST DAMAGED IDENTIFICATION OR ITEM NUMBER SHORT ON INVENTORY DESTROYED DESCRIPTION OR NOMENCLATURE UNIT OTHER UNIT COST QUANTITY TOTAL COST GRAND TOTAL 4. EXPLANATION See instructions Initiator Signature 5. ADDITIONAL INFORMATION See instructions Title Date Prop* Mgmt. or Accountable Officer Name Created by PSC Media Arts 301 443-2454 EF 6. APPOINTING ACTION* The individual s named below shall constitute a Board of Survey and shall investigate the above matter item ...

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