Site Analysis Form

Please fill out the site analysis form below to the best of your ability so we can design the optimal solution for removing contaminants from your groundwater.

Basic Information

Customer/Utility

Site or Well Identity/Location

Local Engineer/Firm

Other Pertinent Notes

Operator

Target Date for Installation

Treatment Goals

Rep Information

Date

Site Contact

Contact Phone

Rep Contact

Fax

Email

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

pH

Total Arsenic

mg/L As

As(III)

mg/L (if known)

Total Sulfides

mg/L (total sulfides)

Phosphate

mg/L P04

Alkalinity

mg/L @ CaCO3

Calcium

mg/L Mg

Magnesium

mg/L Mg

Radium

pCi/L Ra 226/228

Hardness

mg/L @ CaCO3

Silica

mg/L SiO2

Sulfides

mg/L

Sulfate

mg/L as SO4

Iron

mg/L Fe

Manganese

mg/L Mn

Sodium

mg/L Na

Bicarbonate

mg/L HCO3

Total Organic Carbon

mg/L TOC

Ammonia

mg/L NH4 +

Nitrates

mg/L as NO3

Chlorides

mg/L Cl

Conductivity

umho/cm

Turbidity

NTU

Uranium

mg/L U

Gross Alpha

pCi/L

TDS

mg/L

Fluoride

ppm F

Suspended Solids

ppm

Temperature

degrees F

Tannins

mg/l

Chromium VI

mg/l

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