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Get Gas Integrity Test & Gas Turn-On Affidavit 2009

Ving jurisdiction. ___________________________________ (Building Address / City or Town / Zip Code) Complete All Sections That Apply Blue Card #: _____________ Lockable valves and test ports installed/exist at the base of each riser YES NO (circle one) Gas Turn-On requested for the following equipment (specify): ___________________________________________ ___________________________________________ Contractor to Check Appropriate Corrective Condition: I have repaired and tested, _____ Le.

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