ADELANTO ICE PROCESSING CENTER

DETAINEE GRIEVAN CE FORM
CASE 5/951 00 5/5

mm); (We) (WW (mum; (bums)
tummy-W DORM (DORMITURIDI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(DEMO)
- IQ 21mg
unarm?uu uniuu. 1111. ?1?14 1?1. 1.111.va BAIT-E GRIEVANCE WRITTEN
(DMUIIC)
.5) a d?
GRIEVANCE COORDI .. . . m. mm m. mm DATE GRIEVANCE RECEIVED

 

 

 

 

 

STATEMENT OF GRIEVANCE:

   
 
 

   
 

 

 

 

 

 

 
    

 

 

 

 

 

 

 

 

 

 

 

 

1 - I
gg'? :Ccnr?i me Hat bf was
when the ?rc?d ?l his a \1 nuall. up? .15 ?ab h- 
WW: ?me0) \sn?A?
here *0 :5un L152 "Then cm 1 snitg'z
RELIEFSOUGHT:
GRTEVANCE FINDINGS:

r)

 

 

?ka

 

 

 

(MERE)

 

 

DEPARTMENT HEAD SIGNATUREIDATE:

o7 o? <16?
(mines)

WM z/zz?s/

 

 

 

 

 

 

ASS .. 
REVIEWED BYIDATE:
FACILITY 
White: Grievance Copy
Canary: Detainee Records Copy
Pink: Detainee Copy
Remf D4l24l15

 

2018-ICAP-0004T8 800