test Contact Information 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 = Arsenic 2 = Arsenic, Iron / Mn / S project 3 = Fluoride project 4 = Uranium, Radium project 5 = Nitrate project 6 = 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 How did you hear about Adedge? Please Select Internet Search Print Ad Press Release Referral Other Questions? call toll free (866) 8ADEDGE or (678) 835-0052
