CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001300070004-8
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: April 5, 2000
• Sequence Number: 4
• Publication Date: April 6, 1979
• Content Type: REPORT

U.S. GOVERNMENT PRINTING OFFICE: 1974 -558 - 057
ATE
pusWt IF 0 0R1dba=MTff141TJ 19-96-00788R 01300070004a
For use of this form, see AR 380.5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence. pr
5 SECTION A - GENERAL
CONTROL, LOG CLASSIFI-
OR FILE NO. CATION
SG1I
DAMI-ISH
WASH DC 20310
REGISTER OR CONTROL NO
NUMBER OF DESCRIPTION (Type, File Ref., Unclassified Subject DATE OF
COPIES or Short Title and Number of Indorsements/D1cls) DOCUMENT
L 1 SRI 9-4107, Proposed GRILL FLAME 23Mar7 SRI
Protocol (U), cy #9
===========NOTHING FOLLOWS====== ====
TO I COPY NO. I DATE I PRINTED NAME I SIGNATURE
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN:
0 DESTROYED D 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. ISIGNATURE
PAGE OR COPY NUMBER DATE PRINTED NAME OF WITNESSING OFFICIAL ISIGNATURE
NUMBER OF COPIES TO BE REPRODUCED AUTHORIZED BY
DATE
rM ECEIPT OF DOCUMENT(S) ACKNOWLEDGED E] DOCUMENT(S) HAVE NOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
'l l.,.V'. ---t C1
REPLACES DA FORMS 1203, 1 SEP 58: 1204, 1 JAN 60: 631, 1 MAR 62 AND
546, t OCT 63, WHICH ARE OBSOLETE.
SG1I
Approved For Re&Ae 2000/08/07 : CIA-RDP96-00788R001300070004-8