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City of Fridley
Water Department
Address 1 / .J 't �" � ��� v`�-
Name�f�� J�A��,CyC.�,�
� Date � � `p��-��
Old Meter Number � ���
Old Meter Readin � �J
Replacement No. �Ar'���`� �{��
Replacement Reading �
eplacement Make�+�,71,�--
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ERT# r t� ���� `
Replacement ERT# ,
Remarks: ��
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