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ALAMEDA COUNTY OFFICE  

INMATE IEVANCE FORM
]Santa Ritalail Glenn E. Dyer Detention Facility

NAME: Darrell Punchline. DATE: 5- 

Only one grievance issue perform (Subject to refusal {ffo?ure to comply) DATE GRIEVANCE OCCURRED 1 

 

 

 

Grievance Detailsheath. Emlyn' as. L}mm
pi: "m lame (ERA  Mai/11:. ominionenew? rekurnerk 3m meal have. ?namely laceifs-4 M-

?ggn ng? {a ?ag much pain Mrs. mammals:
I. 
m'"1mi; gimme, imam Mme am new!? mainsand-I. I . . 4-.- .. -. .. .
W. in 06m. ml we. her-?er
Magda?: gm wage! a. 1's. . fa"?   1- We."  

I

 

SIGNATURE:  Ebem?m

By signing form, you are consehtln to a search ofyour medical, dental, or mental health records for the purpose of this Investigation only. This
acts as a waiver to your rights. 1! you disagree with this, you must indicate so In your grievance.

WRITE ON BACK OF THIS FORM. USE ADDITIONAL GRIEVANCE FORMS IF 
I NOT WRITE BELOW THIS 

 

 

 

Received by Deputyr Badgel?-l Date: .0506 if
]\Resol\red at Deputy Level I Inmate Acceptance (Signature) 

 

Wannot be resolved agDeputv Level Grievance Tracking Number: [53?  

The Deputy who recelved the Inmate?s grievance shall ottochon Inmate Grievance Response Supplemental Form (MLFS )dctoillng

how they resolved or attempted to resolve the ?rm: are?s grievance.   - VCR.  
 . -    I I M'L?51lrev 10/14)

Copies: White-Staff
Plnk?lnmete