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City of Fridley
Water Department
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Name r��'a.ia. / �J. s�v�`r 4 ►1
Date �—�l�— O�
Old Meter Number �����3�9�
Old Meter Reading 3 �� t;f
Re cement No. �9 ��,�� `��`
Replacement Reading �
Replacement Make ''��''�J'-��—
ERT# /'�' / �� 9' f�
Replacement ERT#
Remarks: �.� �
Signed �..�'� ��3�