Wastewater, Waste Water, Wastewater Treatment, Equipment, Process, Chemical, Management, Industrial

P.O. Box 3182 -- Monument, CO 80132
Phone: 719.439.8491 -- Fax: 719.218.9701

"PROVIDING SOLUTIONS THAT BRING IT ALL TOGETHER"

KNOWLEDG CENTER INFORMATION REQUEST FORM

This information request form is used by our "Knowledg Center Team" to tailor a system for your specific application. Please fill in the boxes where applicable.
	Please contact me directly to discuss several items
	Please send me additional information on:
		Chemicals (Coagulation / Flocculation)
		Chemical make-down equipment
		Flotation systems
		Sedimentation systems
		Dewatering
		Service (Bench / Pilot program)
		Analytical services

APPLICATION DATA SHEET

1. Contact Information

Please provide as much information as possible.
Company (name) *:
Address:
Telephone number:
Fax number:
E-mail address *:
Contact person *:
Type of industry:
Information needed by:

2. Process Data

Existing situation / results:
Desired situation / results:

3. Influent Characterization

Waste type (i.e., municipal, petroleum, etc.):

Wastewater source
(please list):

I)
II)
III)
IV)
V)

Treatment to include:

	Domestic waste
	Commercial waste
	Weather runoff
	Other

Other:

Plant operation:

hr / day

Present mode of discharge:

Existing treatment systems, including in-house activities to minimize pollution discharge:

Average / max. flow rate:

Intermittent batch discharges:

I. If intermittent:

source:
duration of discharge:
flow rate:
frequency:

II. If batch:

source:
batch size:
frequency:
discharge rate:

Physical appearance/ characteristics - total waste water:

a. type of contaminants:

b. solids type (i.e., fibrious, abrasive, crystalline, etc.):

c. appearance:

color:
turbidity:
odor:

d. density of material:

gm / cc

e. quantity of material floating:

f. particle size distribution
(if available):

g. necessary precautions:

h. permissible floc/chemical treatment
(if available):

Laboratory Analyses (if available):

Temperature:

deg.C

pH:

std.units

TSS:

mg / L

BOD5:

mg / L

COD:

mg / L

TDS:

mg / L

FOG:

mg / L

Turbidity:

NTU

Others:

4. Target Discharge Requirements:

Is your discharge government regulated?

Yes No

Which standards?:

Is a copy available?

Yes No

Visual appearance of the waste effluent required?

- Color:
- Turbidity:

pH:

standard units

COD:

mg / L

BOD5:

mg / L

TOC:

mg / L

Oil concentration:

mg / L

Method of analysis for oil employed:

FOG:

mg / L

TSS:

mg / L

TDS:

mg / L

Others:

5. Desired Degree of Product Recovery and Water Reclamation

Will the treated water be:	Discharged Re-used
	In case of re-use please give the specifications for the water to be re-used

Are the impurities to be recovered?	Yes No
	In case of recovery please specify any chemicals that may not accompany the material to be recovered

6. Desired Degree of Product Recovery and Water Reclamation

	Above ground sump others
Materials of construction:	Stainless mild steel FRP others
Installation location relative:	indoors outdoors off-shore others
Is electricity available? If available, please specify:	Yes No V Hz
Is clean fresh water available? If available, please specify:	Yes No head capacity gallons per minute

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