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APPLICATION FOR WATER EVALUATION & DEOXIDATION

Addressed TO:

..............................Priority:

Your name:
Your E-mail:
Subject: po
Your Company Name:

Type of Business Activity:

Company's Tax ID Telephone GPS
Your address:

Address and GPS of water source if different then company:

Brief description of water source to be evaluated including flow capacity per hour:
YES NO
We , hereby do certify, that we have a legal access to the water source and officially granted, legal permission to use the water for the evaluation purposes.
YES NO We are hereby applying for water Oxidation Reduction Potential evaluation, and certification based on true properties of the original water source above described.
YES NO We are interested in water de-oxidation program based on the result of ORP evaluation.
YES NO Please send us service agreement