Please provide the following contact information:

            Name 
           Title 
         Company Work Phone 
  Street Address        FAX 
 Address (cont.)     E-mail 
            City   Web-Site 
  State/Province 
 Zip/Postal Code 
         Country 

Application Information: (Please complete as much as possible)

1.  Wastwater Flow Requirements:

1 Gallon Per Minute	5 Gallons Per Minute	10 Gallons Per Minute	15 Gallons Per Minute
20 Gallons Per Minute	25 Gallons Per Minute	Other

 

2.  Facility Power Voltage Requirement:

115 VAC-1Ø-60 Hz	208 VAC-1Ø-60 Hz	230 VAC-1Ø-60 Hz	460 VAC-1Ø-60 Hz
208 VAC-3Ø-60 Hz	230 VAC-3Ø-60 Hz	460 VAC-3Ø-60 Hz	Other

 

3.  Wastewater Process Chemical Components To Be Treated:

Test Sample Provided                  Date:
Current Wastewater Effluent pH Level:
Required Treated Effluent/Drain pH Level:

  

Chemical(s) Description	Ratio/Mix	Effluent Status
		Diluted	Concentrated
		Diluted	Concentrated
		Diluted	Concentrated
		Diluted	Concentrated

 

4.  Desired Model Features: (select all that apply)

Standard

External Source Transfer Pump

Treated Output Transfer Pump

Outdoor Placement

No Stand

Stand Height

Stand Material

Standard Gravity Bag Filtration (150 Micron)

Deep-bed Filter (20 Micron)

Carbon Filter

Sand Filter

Special Filtration

Output pH Monitoring/Alert

Output pH Treatment

Output pH Chart Recorder/Remote Data Logging

 

5.  Additional Features / System Components: (select all that apply)

Ext. pH Pre-Adjust Tank: Size/Volume	Ext. Feed Pump:Type
Ext. Post-Treatment Tank:Size/Volume	Ext. Feed Pump:Type
Closed-Loop Recycle System-Piping Material Requirements(Temp)
Ext. Recycle Reser. Tank:Size/Volume	Ext. Feed Pump:Type

   

6.  Special Requirements / Notes:

 

8.CODE