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Get TX Test and Maintenance Report - Lubbock 2010

LUE INK / ILLEGIBLE OR INCOMPLETE REPORTS WILL NOT BE ACCEPTED Backflow Assembly Information – Please Print Serial Number: ________________ Manufacturer: _______________ Model: _______________ Size: ________ Is this a commercial property? Yes No Phone Number of Contact : ___________________________ (business / customer) Business/Customer Name: __________________________________________________________________________________________ Physical Address: _______________________________________.

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