WASTEWATER EVALUATION FORM
(INDUSTRIAL)
Contact Information:
Date:
Name:
Project Address:
Street:
City, State:
,
Zip Code:
Country:
Engineer:
E-mail:
Phone Number:
Fax Number:
Project Name:
Project Location:
Name of Buyer
(End user of Contact):
Project Classification:
Manufacturer
Food Processor
Industrial Plant
Type of Wastewater Flow:
Industrial Only
Employees Only
Combination
Size:
GPD/LPD
Hourly Peak Flow
GPD/LPD
Elevation (ft) ASL
Plant Information:
Hours Plant is Running:
Number of shifts per day:
Number of days per week plant operates:
If plant has peak flows please describe in full detail when, how long, how much, etc.
If the plant shuts down for a longer period of time than 24 hours?
If so, describe:
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:
Information Request :
Please send me a product brochure.
Have a representative contact me.
To compete the form click "Submit Part One!"
