WASTEWATER EVALUATION FORM
(NON-INDUSTRIAL/DOMESTIC)
Contact Information:
Date:
Name:
Street:
City, State:
,
Zip Code:
Country:
Engineer:
Email:
Phone Number:
Fax Number:
Project Name:
Project Location:
Name of Buyer
(End user of Contact):
Classification of Project:
Subdivision
Mobile Home Court
Municipality
Type of Wastewater Flow:
Domestic
Commercial
Combination
Size:
GPD/LPD
Hourly Peak Flow:
GPD/LPD
Elevation(ft)ASL
Optional Equipment Needed:
Sand Filters
Carbon Filters
Lift Stations
Grease Traps
Trash Traps
Pumping Systems
Aeriation Packages
Disinfected by:
Chlorine
UV
Discharge Use:
Irrigation
Stream
Lake
Land Apply
Other
Project Stage Now:
Preliminary Budget
Purchase in 90 days
Purchase in 6 months
Electrical Supply:
Phase:
Hz:
Volts:
Organic Loading:
Wastewater Characteristics of Influent
Parameters to Meet
1. BOD5 MG/L
2. TSS MG/L
3. PH MG/L
4. Ammonia MG/L
5. Other
Information Request :
Please send me a product brochure.
Have a representative contact me.
To compete the form click "Submit!"
