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REQ~ TO DORADUS COR.PO~ON FOR EIVIERGENCY <br /> SERVICE OF SIR.F..N REC~ECODF_~ <br /> <br />Date r~u~strxl f~ emergency ~ervice is made: <br /> <br />Entity ma.king request (Nme of City or County): <br /> <br />Nme of person and title of person making request: <br /> <br />Name, title, telephone number and facsimile machine number of person Domdus should contact regm'ding this <br />request: <br /> <br />Nltme of ~erson <br /> <br />Title of p~rson <br /> <br />Telephone number <br /> <br /> Facsimile ~fax) machine number <br /> <br />Emergency serviceis requested for the following unit: <br /> <br />Unit number <br /> <br /> CiD' in which mt is located <br /> <br /> Location o'i* unit <br /> <br />Description of problem with unit.. (Provide as much detail as possible): <br /> <br />The telephone numl}er of Doradtts is (612) 572-1000 as of September 1, 1994. The facsimile (fax) number of <br />Doradus is (612) 572-392? as of September 1, 1994. <br /> <br />Doradus acknowlextges receipt of this request on <br /> <br />Name and title of Doradus personnel acknowledging re. eipt: <br /> <br />(date) · <br /> <br /> <br />