ADELANTO ICE PROCESSING CENTER

DETAINEE GRIEVANCE FORM
AR- 00300)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(tam-(C) 
?t 
(MGHC)
EMA) DATE WRITTEN
(DMD)
GRIEVANCE COME DATE GRIEVANCE RECEIVED
STATEMENT OF GRIEVANCE:
- (tuna). (WED) a: e- AND

 

 

 

 

T9 345.11." 
TE. 

RELIEF SOUGHT:

 

 

 

 

 

 

GRIEVANCE FINDINGS:

 

J/cm- (/Emi

 

 

 

JV
DEPARTMENT HEAD SIGNATUREIDATE: ?493 .

(103(5); (WUHC) 
REWEWED BYIDATE: 1/ I 2 77 Ag/

 

 

 

 

 

ASSISTAL
REVIEWED BYIDATE:
FACILITY ADMINISTRATOR
White: Grievance Carry.f
Canary: Detainee Records Copy
Pink: Detainee Copy
Rev 04f24/ 15

 

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