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First Name:*
Last Name:*
Company Name:
Title/Position:
Address 1:*
Address 2:
City Name:*
State Name:*
Zip/Postal Code:*
Country Name:*
Phone No.:*
Fax No.:
Email ID:*
Location of Planned Installation:
Treated Water Requirements:
Per Day:
 Per Hour:
Ultimate use of treated water:
Quality of water required:
Facility - describe existing facility and any problems with facility:
Space for New Equipment:
Length:
 Width:
 Height:
Location:
 Power (Volts):
 Max. Amps:
Phase:
 Cycles:
Feed to Proposed Treatment Facility:
Seawater Municipal Well
Surface Blend Water
Other:
Feedwater Temperatures (units):
Average:
Highest:
Lowest:
Feedwater Pressure:
Lowest @ full flow:
Highest @ 0 flow:
Feed Analysis - complete table and include all items requested in PPM as ion in water treatment:
pH:*
Total Dissolved Solids (ppm):*
TSS:
TS:
Turbidity:
Fecal Coliform:
Strontium (Sr+2):
Barium (Ba+2):
Carbonate (CO3-2):
Bicarbonate(HCo3-):
Nitrate (NO3-):
Chloride (CI-):
Fluoride (F-):
Sulfate (SO4-2):
Silica (SiO2-):
Boron (B+3):
Iron (Fe+3):
Hardness (as CaCO3):
Feed Analysis - complete table and include all items requested in PPM as ion in wastewater treatment:
pH:*
COD:
BOD:
TS:
TSS:
TDS:
Ammonia:
TKN:
TOC:
Floating Oil & Grease:
Emulsified Oil & Grease:
Phenol:
Turbidity:
Color:
Phosphate (Po4+3):
Ca+2:
Mg+2:
Chromium Cr+3:
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