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Get NYC GEN215B 2008

____________________________ Plumber’s License #: _______________________________________ Telephone #: _______________________________________ Signature, Seal and Date: Minor Installation Changes (describe): Attach additional sheets if required. NOTE: Send one completed form with original ink signatures and original ink or impressed seals to NYC Department of Environmental Protection, Division of rd Permitting & Inspections, Cross Connection Control Unit, 59-17 Junction Boulevard, 3 Fl.

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