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Customer/Utility
Date (mm/dd/yy)

Site or Well Identity/Location
Site Contact

Local Engineer/Firm
Contact Phone

Other Pertinent Notes
Rep Contact

Operator
Fax

Target Date for Installation
Email*

Treatment Goals
Rep Information

System Parameters / Site Specific Info



System Type /Application
(utility, school, MHP, other)

Population Served
(estimated)

Number of Connections

Number of Wells to be Treated
(# wells to be treated)

Design Flow (GPM)
(max design flow rate)

Ave Flow (GPM)
(typical demand)

Adedge Sizing Basis (GPM)
(sizing basis-Adedge)

Est. Gallons per Day
(Av. throughput per day)

Est. Gallons per Year
(Best estimate)

Existing Pretreatment or disinfection?

Equipment available for offloading

Pump/Operation Pressure

Available Electrical Supply

Electrical Power Availability

Atm Storage Tank Present / Size

Hydropneumatic Tank Present / Size

Building Present

Any Additives ie, phosphates, fluoride

Discharge Options Available
Site Specific Notes:

Water Analysis

Project Specific Parameters

Codes:

1 = Arsenic2 = Arsenic, Iron / Mn / S project3 = Fluoride project4 = Uranium, Radium project5 = Nitrate project6 = General Filtration

(Enter all available)

CODES

PARAMETERS

All
pH

1, 2
otal Arsenic
mg/L As
1, 2
As(III)
mg/L (if known)
All
Total Sulfides
mg/L (total sulfides)
All
Phosphate
mg/L P04
All
Alkalinity
mg/L @ CaCO3
All
Calcium
mg/L Mg
All
Magnesium
mg/L Mg
All
Radium
pCi/L Ra 226/228
All
Hardness
mg/L @ CaCO3
All
Silica
mg/L SiO2
All
Sulfides
mg/L
All
Sulfate
mg/L as SO4
All
Iron
mg/L Fe
All
Manganese
mg/L Mn

Codes

Parameters


All
Sodium
mg/L Na
3, 4, 5
Bicarbonate
mg/L HCO3
All
Total Organic Carbon
mg/L TOC
All
Ammonia
mg/L NH4 +
4, 5
Nitrates
mg/L as NO3
4, 5
Chlorides
mg/L Cl
All
Conductivity
umho/cm
All
Turbidity
NTU
4
Uranium
mg/L U
4
Gross Alpha
pCi/L
3, 4, 5
TDS
mg/L
3
Fluoride
ppm F
All
Suspended Solids
ppm
All
Temperature
degrees F
All
Tannins
mg/l
All
Chromium VI
mg/l

 

 

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