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Liner and Geomembrane Information and Quote Form

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Liner Type :

Installation - City, State:
Description of Liquid (Describe content of liquid, including pollutants and expected temperature extremes in basin and at application point):
Operational Characteristics (Describe the operation of the facility such as filling schedules, fluctuating fluid levels, operation temperature, etc.):
Performance Requirements (State any other requirements, such as rate of permeability, etc required):
Reference Materials:
Installation Owner and Address:
Expected Date of Installation:
Expected Beginning Date of Service:
Description of Application (Ex: impoundment used to contain brine on an emergency basis):
Physical Features of Application (Example: 1.3 million gallon earthen impoundment with overall top dimensions for 160’ x 160’ with 3:1 slopes and 10 ft deep):
Width Dimensions:
Length Dimensions:
Anchor Trench Dimension:
Special Requirements: