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~~ <br />Fr-e~_cr-i br:~d L-cur ni nr~ I~') ,~r~ <br />~ GI - <br />lrappczr htlning ].nc. <br />District ~±c.,-,mhoa+- i;t-~ringr, <br />1~~~ -----t-,~.t ~__3 ~0_~~~~------ <br />Fire htgrn~t. ~/ <br />Frep~~.red riy 7e=rry L.. Wrt-t ). r•=_ Gatc -.~_•/8`; <br />District <br />Forester _~~~~iJ"~~~'~"_-`-^f~ate-----3~}-~ 6 q <br />F:ppr'oved by_-- <br />F-lree, For-ester <br />Respon=_ib)e Ir,dividut~)s: <br />Appro~•i nra Li nr- <br />F'lar~ <br />Er<rxuti en <br />Date Fire Out <br />Certifi:d by_______ <br />Title <br />-------------- <br /> <br />Prescribed L'ur-n~.ng Loss <br />n:,,.•~ :.r••i •1~: sss <br /> <br />____ Fr-escr-ibed Fire I•ianager: <br />_____ Frim.~ry: <br />___-- Alter-na.te:--------------- <br /> <br />