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2. Name
4. Address
6. Phone
8. Email
10. Location of Problem
12. Date
    Date

    Date
14. Description of Problem
16. The complaint should be submitted by the grievant and/or his/her designee as soon as possible, but not later than 30 calendar days after the alleged violation to:
    
    Sandi Countryman
    HR Director
    PO Box 1310
    Artesia, NM 88211-1310
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18. 1. Receive an email copy of this form.
19. Email address

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