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Name Address DOH-3682 8/10 Additional Center Contact Alternate person in charge of this center on a daily basis PAGE 1 OF 4 HOURS/MEALS Schedule C1. Approval Type Each license registration or operating certificate as well as each location is considered to be a separate center and requires a separate application DOH-3682. I also certify that this center is not participating in the Child and Adult Food Program under any other organization. Please .

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