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XR® Membrane Application and Utilization Form <br /> Installation Owner and Address: <br /> Physical Location of Installation: <br /> Expected Date of Installation: <br /> Expected Beginning Date of Service: <br /> Description of Application: <br /> (Example:impoundment used to contain brine on an emergency basis.) <br /> Physical Features of Application: <br /> (Example:1.3 million gallon earthen impoundment with overall top dimensions of 160'x 160'with 3:1 slopes and 10'deep.) <br /> 27 <br />