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Date: <br /> 1. Food and/or beverage served. <br /> 2. Permit(s) attached. <br /> 3. Food cooked. <br /> 4. Permit(s) attached. <br /> 5. List other health licensing obligations as may be require: <br /> � <br /> � <br /> I <br /> l i <br /> � <br /> Page 10 of 10 <br /> 21 <br />