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SUFFOLK COUNTY WATER AUTHORITY REPORT ON TEST AND MAINTENANCE OF BACKFLOW PREVENTION DEVICE 215B 4060 Sunrise Hwy/PO BOX 38 Oakdale NY 11769 631 563-0266 Ph 631 218-1145 Fax A separate form must be completed for each device For the Year PLEASE NOTE INCOMPLETE FORMS WILL NOT BE PROCESSED AND RETURNED TO THE CUSTOMER SCWA Contract Account Location of RPZ/DCV Facility Name Address Street Device Information City Manufacturer Zip RPZ DCV Model Size in.

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