Figure: 25 TAC §289.201(m)(2)(A)(ii)

"INFORMATION FALLING WITHIN EXCEPTION OF THE TEXAS PUBLIC
INFORMATION ACT, GOVERNMENT CODE, CHAPTER 552----CONFIDENTIAL

This document contains information submitted to Radiation Control, Department of State Health
Services by __________________________________
                    (Name of Company) (Name of Submitter)

that is claimed to fall within the following exception to the Texas Public Information Act,
Government Code, Chapter 552, Subchapter C _________________________________
                                                                                     (Appropriate Subsection)

WITHHOLD FROM PUBLIC DISCLOSURE

_________________________________
(Signature and Title)    (Office)   (Date)"