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Get Gen215b 2019-2024

Lete entire form Part A- TO BE COMPLETED IN ALL CASES Annual Test For the Year . Complete Parts A & B Only Public Water Supply: NYC-DEP County: Name & Address of Facility: Block: Lot: Department Use Only Make & Model # of Assembly Size & Serial # of Assembly Location (Floor) of Assembly: Part B- TO BE COMPLETED BY NYS CERTIFIED BACKFLOW PREVENTION.

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