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EmEgGENcY NOTIFICATION FOR THIS FACILITY ANDIOR PROGRAM <br /> CONTACT PERSON L' -�s�. b--Qn("IP zz _ Day Ph 71-02I$-12 SVU(o Night Ph?_Qq Sc-,',7- S--(,5 <br /> PROGRAM ELFIN �' FEF 7 J Surcharge F4E <br /> r' Other FFF <br /> INSPECTOR �• PERMIT VALI CQ l <br /> 'j S��" 6 t �`� Food Handler <br /> , <br /> Check r AMOUNT AI 'b Dat INVOICE# <br /> Cas REVIEWED BY ACCOUNTING OFFICE Date <br /> RETE QED <br /> SUN 0 ?014 <br /> E,4y AQUPN Ca <br /> N�IiHUF 4 hl <br />