Part C: Canadian Warehouse Information

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Warehouse Company Name:

Building Name (if applicable):

Date of last Drug GMP inspection (yyyy-mm-dd):

This warehouse is used for storage of products from DEL # (10XXXX-X):

Street Address:

Appt. / Suite:

Post Office Box:

City:

Province

Postal Code:

Contact Person and Title:

Language:   English or French

Telephone:

Fax:

Email: