Water System Inquiry

Customer:

Name: *

Address: *

Phone: *

Fax: *

Contact: *

E-mail: *

Distributor / Agent: *

Water supply:

Reservoir

Lake

River

Well

Name: *		Type: *
Depth: *		Age: *

System Capacity:

Gal. / Day: *

Daily hours of use: *

Maximum flow daily: *

GPM: *

Treated Water Storage:

Gallons:		Type:
Proposed:		Existing:

Raw Water Storage:

Gallons:

Type:

Enclosure:

Existing:		Proposed:
Size:

Backwash Capabilities:

T.W. Backwash:

Water Usage:

Potable: *

Industrial: *

Attach Water Analysis:
Completed by:

Existing Treatment: *

Desired objectives:

TDS		mg/l	Turbidity		units	NaCl		mg/l
BOD		mg/l	pH		units	Fe		mg/l
Mang		mg/l	Color		units	DO		mg/l
Hard		mg/l	Temp.		°C	TSS		mg/l

Total Organic Carbon:
Trace Metals:
Others:

Drinking Water Standards:

Can State EPA Other:

Comments:

Type the characters you see in the picture:

NOTE:    ATTACHMENTS WILL BE UPLOADED AFTER CLICKING SUBMIT