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| # |                   |   |                   |   |   |   | ##    |      |
|   |                   |   |                   |   |   |   |  Date |      |
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+---+-------------------+---+-------------------+---+---+---+-------+------+
| * |                   |   |                   |   |   |   | ###   | #    |
| * |                   |   |                   |   |   |   | # Ini | ###  |
| T |                   |   |                   |   |   |   | tials | Date |
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|   | Action            |   | File              |   |   | N |       |      |
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|   | Approval          |   | For Clearance     |   |   | P |       |      |
|   |                   |   |                   |   |   | e |       |      |
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|   |                   |   |                   |   |   | C |       |      |
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+---+-------------------+---+-------------------+---+---+---+-------+------+
|   | As Requested      |   | For Correction    |   |   | P |       |      |
|   |                   |   |                   |   |   | r |       |      |
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+---+-------------------+---+-------------------+---+---+---+-------+------+
|   | Circulate         |   | For Your          |   |   | S |       |      |
|   |                   |   | Information       |   |   | e |       |      |
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|   |                   |   |                   |   |   | M |       |      |
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|   | Comment           |   | Investigate       |   |   | S |       |      |
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|   | Coordination      |   | Justify           |   |   |   |       |      |
+---+-------------------+---+-------------------+---+---+---+-------+------+
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+---+-------------------+---+-------------------+---+---+---+-------+------+
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|   |                   |   |                   |   | e |   |       |      |
|   |                   |   |                   |   | N |   |       |      |
|   |                   |   |                   |   | o |   |       |      |
|   |                   |   |                   |   | . |   |       |      |
|   |                   |   |                   |   | * |   |       |      |
|   |                   |   |                   |   | * |   |       |      |
|   |                   |   |                   |   |   |   |       |      |
|   |                   |   |                   |   |   |   |       |      |
|   |                   |   |                   |   |   |   |       |      |
|   |                   |   |                   |   |   |   |       |      |
|   |                   |   |                   |   |   |   |       |      |
|   |                   |   |                   |   |   |   |       |      |
+---+-------------------+---+-------------------+---+---+---+-------+------+