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Residential POE Site Profile Form

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Please complete the form below. Alternatively, you may download the form to print, and fax completed to (678) 835-0057.

*Email is required

Contact Information

Customer		Date (mm/dd/yy)
Location		Dealer Contact
Source of Lead		Phone
Competitive Technologies Considered		Fax
Desired Install Date		Email*
Other Pertinent Notes

System Parameters

Application		(residential, other POE, commercial, other)
Size/Type		(Single family, multiple family, etc.)
Design Flow (GPM)		(Max design flow rate)
Average Flow (GPM)		(Typical demand)
Gallons per Day		(Av. throughput per day)
Est. Gallons per Year		(Best estimate)
Softner Installed	Yes No
Iron or Manganese above MCL?	Yes No
Sulfide Odor?	Yes No If yes, describe treatment
Existing Treatment

Water Analysis

(enter all available)

pH*		Antimony	ppb Sb
Total Arsenic*	ppb	Cadmium	ppb Cd
Phosphate*	ppm	Chromium	ppb Cr
Alkalinity	ppm CaCO3	Turbidity	NTU
Hardness*	ppm CaCO3	Lead	ppb PB
Silica*	ppm SiO2	Vanadium	ppb V
Sulfides*	ppm	Molybdenum	ppm Mo
Sulfate	ppm SO4	Selenium	ppb Se
Iron*	ppm Fe	Fluoride	ppm F
Manganese*	ppm Mn	Suspended Solids	ppm

*priority parameters

Questions? call toll free (866) 8ADEGE or (678) 835-0052

ADEDGE TECHNOLOGIES, INC.
5152 Belle Wood Court - Suites A & B - Buford, GA 30518 USA
1.866.8ADEDGE toll free - tel 678.835.0052 - fax 678.835.0057
Webmaster: Joseph Naylor - joe@adedgetechnologies.com
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