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April 17, 2019

10:00 AM

SION IN SflT- IFS 36,1611u ,H)19

PRC.JLCT 6L.L-913,113j1 in #7, ChillEr #2, Air Cooled later ('ruiller Rr HrpLaLlrl, tilt\ Palo aito Gloalth Care r7viste

, 'w14 Palo Alto, CA

Complete the foiii4.42iFf-, ,j

11. Company Name: 570f-TP-€5/c-

Company Representative: ,D4V(2) RzyzYS

Phone # 7e97 S'O -04/7Z Email:: i),,,e7.:1574V/Z-5yer/40_570y, as

AulAtional Representative:

FLic # ail:

Additional Representative:

PLgune # mail:

NOLASZ.) (f.',r1c,(3r: etrie of the fulls7vring:

General Contracir

Sub-Contractor

Supplier

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