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NYC-DEP Backflow Prevention Device Approval I am the Designer of Record. I am I am NOT the Licensed certify that it is in accordance with the Building Department s Requirements. 3rd Fl. Low-Rise Flushing NY 11373 NYC - GEN215B Rev. 11/2016 1 62 50 INSTRUCTION FOR COMPLETION OF Report on Test and Maintenance of Backflow Prevention Device FORM GEN-215B Use a separate form for each device Indicate Initial Test or Annual Test by checking the appropriate choice. If the installation changes...
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