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<col style="width: 8%" />
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<td colspan="12"><strong>RECORDS TRANSMITTAL AND RECEIPT</strong>
Complete and send original and two copies of this form to the
appropriate Federal Records Center for approval prior to shipment of
records. See specific instructions on reverse.</td>
<td>PG. 1</td>
<td colspan="2"><p>OF 1</p>
<p>PAGE(S)</p></td>
</tr>
<tr class="even">
<td colspan="7"><p>1. TO <em>(Complete the address for the records
center serving your area as shown in 36 CFR 1228.150.)</em></p>
<blockquote>
<p><strong>FRC Location)</strong></p>
<p>Address</p>
<p>City State Zip</p>
</blockquote></td>
<td colspan="8"><p>5. FROM (Enter the name and complete mailing address
of the office retiring the records. The signed</p>
<blockquote>
<p>receipt of this form will be sent to this address)</p>
</blockquote>
<p>Host Unit</p>
<p>Address</p>
<p>City State Zip</p></td>
</tr>
<tr class="odd">
<td colspan="2"><p>2. AGENCY</p>
<p>TRANSFER</p>
<p>AUTHOR- IZATION</p></td>
<td colspan="4"><p><strong>TRANSFERRING AGENCY OFFICIAL</strong>
<em>(Signature and title)</em></p>
<p>Alison Smith</p>
<p>Alison Smith</p></td>
<td><p>DATE</p>
<p>XX/XX/XXXX</p></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="2"><p>3. AGENCY</p>
<p>CONTACT</p></td>
<td colspan="5"><p><strong>TRANSFERRING AGENCY LIAISON OFFICIAL</strong>
(<em>Name, office and telephone No.)</em></p>
<p>John James (909)-386-2222)</p></td>
<td colspan="8"></td>
</tr>
<tr class="odd">
<td colspan="2"><p>4. RECORDS</p>
<p>CENTER</p>
<p>RECEIPT</p></td>
<td colspan="4"><strong>RECORDS RECEIVED BY</strong> (Signature and
title)</td>
<td>DATE</td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="15">6. <strong>RECORDS DATA</strong> <em>(fold
here)</em></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>ACCESSION NUMBER</strong></td>
<td rowspan="2"><p><strong>VOLUME</strong></p>
<p><em>(cu. ft.)</em></p>
<p><em>(d)</em></p></td>
<td rowspan="2"><p><strong>AGENCY</strong></p>
<p><strong>BOX</strong></p>
<p><strong>NUMBERS</strong></p>
<p><em>(e)</em></p></td>
<td colspan="3"><p><strong>SERIES DESCRIPTION</strong></p>
<p><em>(With inclusive dates of records)</em></p>
<p><em>(f)</em></p></td>
<td rowspan="2"><p><strong>RESTRICTION</strong></p>
<p><em>(g)</em></p></td>
<td rowspan="2"><p><strong>DISPOSAL AUTHORITY</strong></p>
<p><em>(Schedule and</em></p>
<p><em>item number)</em></p>
<p><em>(h)</em></p></td>
<td rowspan="2"><p><strong>DISPOSAL</strong></p>
<p><strong>DATE</strong></p>
<p><em>(i)</em></p></td>
<td colspan="4"><strong>COMPLETED BY RECORDS CENTER</strong></td>
</tr>
<tr class="even">
<td><p><strong>RG</strong></p>
<p><em>(a)</em></p></td>
<td><p><strong>FY</strong></p>
<p><em>(b)</em></p></td>
<td><p><strong>NO.</strong></p>
<p><em>(c)</em></p></td>
<td colspan="3"></td>
<td><p><strong>LOCATION</strong></p>
<p><em>(j)</em></p></td>
<td><p><strong>Shelf Plan</strong></p>
<p><em>(k)</em></p></td>
<td><p><strong>Cont. Type</strong></p>
<p><em>(l)</em></p></td>
<td><p><strong>Auto.Disp.</strong></p>
<p><em>(m)</em></p></td>
</tr>
<tr class="odd">
<td>095</td>
<td>05</td>
<td></td>
<td>1</td>
<td>1-1</td>
<td colspan="3"><p>Permanent Fire Records</p>
<p>Pine Fire June 2004</p>
<p>Closed Sept 2004</p>
<p>See attached detail listing</p>
<p>Final Version – 5/26/2005</p></td>
<td>R</td>
<td>N1-95-05-02-1</td>
<td>1/2025</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

NSN 7540-00-634-4093 Prescribed by NARA

36 CFR 1228.152 135-107 Standard Form 135 (Rev. 7-85)