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<td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | <td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | ||
<td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | <td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | ||
width="20"> | width="20"> </td> | ||
<td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | <td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | ||
<td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | <td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | ||
width="20"> | width="20"> </td> | ||
<td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | <td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | ||
<td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | <td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | ||
width="20"> | width="20"> </td> | ||
<td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | <td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | ||
<td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | <td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | ||
width="20"> | width="20"> </td> | ||
<td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | <td style="border-bottom:2px solid #A3B1BF" width="3"> </td> | ||
<td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | <td style="padding:0.5em; background-color:#e5e5e5; font-size:90%; line-height:0.95em; border:1px solid #A3B1BF; border-bottom:solid 2px #A3B1BF" | ||
width="20"> | width="20"> </td> | ||
</tr> | </tr> | ||
</table><br /> | </table> | ||
<br /> | |||
<table width="100%" border="1" cellpadding="5" cellspacing="0" style="max-width:70em !important;"> | <table width="100%" border="1" cellpadding="5" cellspacing="0" style="max-width:70em !important;"> | ||
<tr> | <tr> | ||
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<tr> | <tr> | ||
<td width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Agency Name</div></td> | <td valign="top" width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Agency Name</div></td> | ||
<td valign="top" rowspan="2" width="40%"> | <td valign="top" rowspan="2" width="40%"> | ||