Watersafe Inc. Watersafe Inc.
Watersafe Inc.
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Questionnaire for Water Treatment Systems Quotation
Please note that all fields marked with an * (asterisk) are required. This is a detailed questionnaire. We understand that you may not be able to supply all the information. Therefore please fill up as much as you can and we will try our best to help you.

First Name*:
Last Name*:
Company:
Position:
Address:
City*:
Country*
State/Province (USA & Canada):
Zip/Postal Code:
Phone*:
Fax:
Email*:
Please Classify your Company / yourself*: End User
Consultant to End User
Other

Water Quality Information
Temperature Unit* Degree F Degree C
Avg. Temperature*
High Temperature*
Low Temperature*
pH*
TDS*
Suspended Solids
Turbidity
Conductivity
Color
Total Hardness
BOD(5 Day)
S.D.I.
C.O.D.
Fecal Coliforms ( /100ml)
Total Coliforms (/100ml)
Enterococci (/100ml)
Water Analysis
Ca ppm HCO3
ppm

Other Contaminants

Organics*:


Odor:


Other:

Mg* ppm CO3
ppm
Na ppm SO4
ppm
K ppm Silica, SiO2
ppm
Mn* ppm Chloride
ppm
Fe* ppm NO3
ppm
Ba ppm PO4 ppm
Cl2 ppm NH4 ppm
B ppm F ppm
Sr ppm

General Information
Treated Water Volume Required* Gallons Per Minute
Gallon Per Day
M3 Per Day
Liters Per Hour
Feed Water Source* Well
Municipal/Tap
Surface (River/Lake)
Seawater
U.F/R.O
Wastewater
Other
Treated Water Use Industrial Use
Bottling Plant
Drinking Water
Pharmacia Use
Irrigation
Wastewater
Swimming Pool
Cooling Tower
Hours of operation* Per Day
Per week
Line Pressure * Bar
Psig
Booster Pump Needed ? Yes No
Treated Water Storage Tank Needed? Yes No
Treated Water Re-Pressurization Needed? Yes No
Comments:

Floor Plan- Space Limitations
Length Feet
Meters
Width
Height
Door Width
Room Layout Drawing Available? Yes No
Tank Space Restrictions Yes No
System will be located* Indoor Outdoor

Electrical Information
Power Supply
Voltage (volts)*
Frequency (Hz)*
Max. Amperage (Amps)*

Water Treatments Checked Below are Available In Plant
PRE-TREATMENT POST-TREATMENT
Size (if known) Size (if known)
Softener - Single Carbon
Softener - Twin Sediment Filter
Multimedia Filter Ozone
Carbon Filter UV Sterilizer
Sediment Filter pH Adjustment
Ozone Chlorine Injection
UV Sterilizer Other
Acid Injection    
Antiscalant Injection    
Chlorine Injection
Other
Water Treatments Checked Below are Needed for Plant
PRE-TREATMENT POST-TREATMENT
Size (if known) Size (if known)
Softener - Single Carbon
Softener - Twin Sediment Filter
Multimedia Filter Ozone
Carbon Filter UV Sterilizer
Sediment Filter pH Adjustment
Ozone Chlorine Injection
UV Sterilizer Other
Acid Injection    
Antiscalant Injection    
Chlorine Injection
Other
Please Recommend your solutions for pre-treatment to me.
Please Recommend your solutions for post-treatment to me.
Please Explain your desired water treatment in field Below:

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