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					I]P IJ1] 6 . '] ]']             FORMAL                 GRIEVANCE                   FORM            .t ll. l.]:
]lAi     9.j
U. S.           DEPARTMENT OF JT'STICE                                                                                                                            FEDERAL BUREAU OF PRISON

        Glrewant          (s)        Local      3951                                                                       Dlrty    Stalion       F.C.L          Lor€tto

  3 . Rep.esentatiwe                     of                                                                         4.     Infomal        .esolutfon             atcenpted     wlth   (nane   Person)
         P.     Glow€!,              2"d vP,     local           3951                                                      warden /      John     Yos t,

  5.    Fed€lal          Prison         Syslen          Directiwe,          Executive           O!de!,      o.      Statute         wrolated:

 14aLer Agreere..,
    s                 !:::cl-p:r-l    Ar ti.le    ::
 P.rst !.ai tr.e/ :,o.;t .r1ers,   at.frtrL::r.i I i..l                                 :
 t'ir!tcr Aqree1leni, Artrcle    1,,1,r
 5 U.S.C. r1t6

 6. In what Fay Fer€ each of th€ above waofared?                  ae specafic.
 Cn Fabr'rarl' :1,    2L':8, Compcu il f: !is       .!,11...1 :.    .ri      ii     :he f:.,.                                             5eir.I              r.       .Ir-r:ij     s:af:-   Ttr. a!trrp.,!-jrl
 Cf   oun.l l!1 {ar in r:he a,),iri,rl a.nt-ar ass::tri.J         r n : , r : , , 1 1 : L ! t i , ; ' r . , r . . : r 1 t r . 1s r : f r     eq!tprLe,ir i:r Ia5 lr.ref, :he pricrrce
 t.r  I.ars.   lhrs   srtLi.rtrr-ra ( r!5..1 a v.].nl lri.l !f   bcL)i lrritrt!L::r,l.-ff:.ir5                         arit          rr:sr.l.        r:n. In..t               i:t.    ii:. D:Iinq  lirti   r.r!:
 rr ..vera:1..    Th-4 .'r:ti:js.rr.,
 cinpou.C.i::.eis        have b..n     ne!t.ri:ie.1   rirtL',lre  ur:ro1 rjd             n,ere..,r!rar..t-                     l l . c r r . r - r o u I r . to I i r . . : s      rer-a

        Date {s)         of     violaraon             (s)

 t       1/ )t)

 8. Request renedy             (i.€.,    what you ranc done)
 l-rr, n!t  !,r..rle    L!!:h ..,fiir.!r,Ll !If1.:',i   s
 ti-.qo:1a:.     arth:h,a       Lr:o.    or (-l::irrres rhnt    nfie.t                            ..l.lr.r..s             ,jf   t:Irt!_i,r,aent, 1ni 1-'d:.1 F.s r .,..iers
 Tra':r all       s:i:a    w]r.                                                                                                                  ')Jl jr r'r :lLei l''r:r(: r.l           lr:i:.1
 r\it.rth.:       rere!l;    .1..ne.i                 :,rn.plrr!prrtr:.                              bt     tt:.        rrtrri:r'.:rr

 9.     Person         with      Fhon         filed                                                                        10, Title
                                                                                                                           !eqr'rnal lr r..l        i).

 11.     Siqnature              of     recapient                                                                           12 . Date     signed

 I     hereby         celtify          that      efforts           at   inforna]    resolution             have          been    un3uccessful_

 13. signature                of crievant              (s)                                                                 14,     SignaCuie       of     Repr€sentative

Recold         copy     - Aqency;             copy          -   Unlon   Local;     Copy     -    council                  prason                             -
                                                                                                                   of                  tocaLs;     Copv           crievant

{This     fom         may be          repfrcaced                vLa wp)                                                                   rhis    forn      replaces         BP 1?6(37)    Daced october   1984.