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TITLE X6 DATE LABORATORY DIRECTOR S OR PROVIDER/SUPPLIER REPRESENTATIVE S SIGNATURE STATE FORM W46H11 If continuation sheet 1 of 4 Y 255 Continued From page 1 This Regulation is not met as evidenced by Based on observation interview and record review on 10/26/11 the facility failed to ensure the kitchen complied with the standards of NAC Findings include 2.
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