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Freeport NIP(8.1)-LR010920 (3)
CtlECK ONE: IRRIGATION BACKFLOW PREVENYION ASSEMBLY TEST AND MAIN~-.~,NCE REPORT PWS LD. # LC~TION OF SERVICE: TYPE OF ASSEMBLY Seri~ Number !~sst~ Vac~n Br~t-~ Amxapl~ Vac~m B~t-~ White - Customer's Copy Yellow - City Copy Pink - Testetas Copy