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%3amax_bytes(150000)%3astrip_icc()%2fSample-Final-blue-6d294ab8024a4cdca8050cc58ab20c42.jpg&cdnurl=https%3a%2f%2fth.bing.com%2fth%2fid%2fR.3ce9e85eb7b0a1bf636ee00d99c20949%3frik%3d%252frBUCimv0cjE5w%26pid%3dImgRaw%26r%3d0&exph=1000&expw=1500&q=Sample+Form+for+Facility+History+Record&FORM=IRPRST&ck=B9CF4E1FB09D7E5E4F52E0F6D8970F15&selectedIndex=8&itb=0)
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