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0 CUSTDN RECORDS 11102.2 PC Authorized Applicant Type ORI (Code assigned by DOJ) CUSTODIAN OF RECORDS Type of License/Certification/Permit OR Working Title (Maximum 30 characters - if assigned by DOJ, use exact title assigned) Contributing Agency Information: DEPARTMENT OF JUSTICE 15798 Agency Authorized to Receive Criminal Record Information Mail Code (five-digit code assigned by DOJ) P.O. Box 903417 Street Address or P.O. Box Contact Name (mandatory for all school submissions) SAC.

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