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Organization responsible for design) (address) 1b. Construction performed by: (name of R organization responsible for construction) (address) 2. Owner of Pressure Retaining Item: (name) (address) 3. Location of Installation: (name) (address) 4. Item identification: 5. Identifying nos: Name of original manufacturer: (boiler, pressure vessel, or piping) (mfg. serial no.) 6. NBIC Edition / Addenda: (National Board No.) (Jurisdiction No.

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