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Xv. Area uxi Ila ry (supplementary) aides available when requested by the individual? <br />Per CFR Tltle 20,29,41 YES® NO❑ <br />Youth Service Provider Information: <br />Ted Kim <br />Print First &, Last Name <br />1 \ 5/22/2020 <br />Service Provider Signature Date <br />2215 N. Broadway Ave. Santa Ana CA 92706 <br />Business Address <br />(714)619-4008 <br />Business Phone Number <br />All information Is subject to validation by SAWDB staff upon approval of award. <br />