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2. Contractor Name*
3. Contractor Phone Number*
5. Contractor Email Address*
7. Property Address*
9. Tag Type*
   -- Select One --RedYellow
11. Description of Impairment*
13. Attachments
15. Someone will contact you within one business day.
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17. 1. Receive an email copy of this form.
18. Email address

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19. Submit

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