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PLC:

a007ct

Agency:

pepin county health department

For:

d a t c p food safety & recreational lic

Phone:

715-672-5961

Address:

740 7th ave west,p.o. box 39
durand, wisconsin 54736

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Middle:

*Last:

*Establishment Name:

*Establishment Address:

*City:

*State:

*Zip:

*Phone Number:

(### - ### - ####)

*Email:

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Subtotal:

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Total:

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