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PL-06-20-1294 hrs
r nlv[SION OF Environmental Health Florida Health Miami -Dade {County QSTDS[Well Division 1181fS 5 261h Street • N11anif. Ft.33175 t'r-r Dace Inspector 6 _� G _�,c, Address ! 0STDS # Comments: Signature f l ! } _ 1 �, CLL..l