Building XXX

P.O. Box 5000

Upton, NY 11973-5000

Phone 631.344.XXXX

Fax 631.344.XXXX

XXXXXXXX@bnl.gov

Memo managed by Brookhaven Science Associates
for the U.S. Department of Energy

date:	Month X, 2021

to:	name(s)

from:	name

subject:	subject

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