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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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