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Company Name (*)
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Client full name
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Fax number
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Phone Number (*)
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Mobile number
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divergence size (*)
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Diameter of the pipe (*)
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Circumference of the pipe (*)
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Duration of the incidence (*)
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Pressure of the water (*)
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Type of Incident (*)
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Pipe quality (*)
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Note:compliting the star mark cases his necessary.
Note: in the event where you do not have any information about the exact size of the pipe, measure the the circumference of the pipe using cloth tapeline and announce it to the company.