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City of Fridley
Water Deparhnent
Address / .�� � .e r.h ( j��
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Name ,��h., �c_1�
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Date �_� ��
Old Meter Number � �
Old Meter Reading �� �
Replacement No. 3 a'���� ��
Replacement Reading �
Replacement Make ��,�
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ERT# �--�,5�,� �—� 9,I
Replacement ERT#
Remarks: �/�1,�. ��S
Signed