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Safe Surface Solutions

    Applicant Information

    Name*:
    Email*:
    Phone*:

    Tank Infomation:

    Tank Size (diameter/height):
    Tank Configuration:
    VerticalHorizontal
    Name of Residue:
    Choose category that best describes residue:
    Wet liquid, thin, non-sticky, water soluble, powder,clearDried/caked on, gel/lotion, slightly sticky, crusty, oily, film/slimyBurnt on, thick, viscous, tar-like, sludge, very caked on
    Available pressure/flow:
    Wash Fluid:
    WaterSolventCausticCorrosive
    Does the application require a 3a rating?
    YesNo
    Number of available openings?
    Size of openings:
    Describe tank obstruction (if applicable, e.g. center agitator):

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